effusion after 1st infusion of Carbo/Pem - 1262700

ssflxl
Posts:204

Dear All

I had my 1st infusion of Carbo/Pem on 2/20 and the day after the chemo, my symptoms were worse. I had more pain in my back and arm - requiring heavy dose of narcotics. then I had progressive sob and today, I went to the Emergency dept and was found to have moderate pleural effusion. I had this tapped and still have quite a bit of rib pain now. I have lung cancer for over 3 years and had not had effusion before, but this developed right after chemo. My onc thinks it may be radiation recall stimulated by Pemetrexed so she think I should take Prednisone. Has anyone had this experience before? I am afraid to go for 2nd infusion now.

thanks

ssflxl

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Reply # - March 10, 2014, 07:22 PM

catdander
Posts:

ssflxl, I'm so sorry your symptoms got worse. I've heard of radiation recall. I'll ask a doctor to comment.

I hope this is a short setback
All best,
Janine

While you're waiting Dr. Weiss had this to say on the subject, "Sudden onset radiation pneumonitis 5 months after completion would be somewhat unusual. The only situation where I can imagine this being a likely explanation is if he received a new medicine that caused radiation recall reaction. Some medicines can cause inflammation at areas of prior radiation.

Cancer cells, by their nature do not follow rules. While you should not jump to the conclusion of progression, it is unfortunately possible for lung cancer to recur quickly despite recent good scans.

Nothing jumps out at me from your post to obviously explain your husband's shortness of breath. Perhaps a good pulmonologist would be helpful?" http://cancergrace.org/forums/index.php?topic=7348.msg55152#msg55152

Reply # - March 10, 2014, 08:11 PM

dr loiselle
Posts: 37

ssflxl -

Radiation recall is poorly understood and fairly uncommon, though a well documented phenomenon. In cases of radiation recall, a chemotherapy triggers immediate inflammation of an area previously treated with radiation. It is best characterized as a skin reaction. For example, a person treated with radiation to the right arm 20 years ago, undergoes chemotherapy now and develops a severe skin reaction only in the area of the arm previously treated with radiation.

Various chemotherapy agents are associated with radiation recall - there are some reports, mostly related to skin, with pemetrexed.

Could the reaction you described be some kind of lung "recall" inflammation related to prior radiation? It is hard estimate without specific knowledge of the prior radiation, some specifics of this cancer, and first hand evaluation of scans, though do not know of any such condition previously reported. I'll have to defer to the expertise of your local physician team.

I hope that helps and best wishes.

Dr Loiselle

Reply # - March 10, 2014, 09:43 PM

ssflxl
Posts: 204

Dr. Loiselle

Thanks for your comments. Whatever it is that I have, it was triggered by chemo, and I did have radiation in the approximate area twice in past 3 years, so I guess my rad onc put these 2 facts together and concluded that radiation recall is what I have. I hope whatever I have, it can be treated with Prednisone taper and won't happen again with my next infusion.

thanks again

ssflxl

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