The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Radiation Pneumonitis: A Possible Lymphocyte-mediated Hypersensitivity Reaction

C. Michael Roberts, MBBS; Elena Foulcher, BSc; John J. Zaunders, BSc; David H. Bryant, MD; Judy Freund, MBBS; David Cairns, PhD; Ronald Penny, DSc; Graeme W. Morgan, MBBS; and Samuel N. Breit, MD
[+] Article, Author, and Disclosure Information

From St. Vincent's Hospital, University of New South Wales, and from Macquarie University, Sydney, Australia. Requests for Reprints: Samuel N. Breit, MD, Centre for Immunology, St. Vincent's Hospital and University of NSW, Sydney, 2010, Australia. Grant Support: In part by grants from The National Health & Medical Research Council of Australia and from St. Vincent's Hospital, Sydney, Australia.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;118(9):696-700. doi:10.7326/0003-4819-118-9-199305010-00006
Text Size: A A A

Objective: To determine if unilateral thoracic irradiation results in a lymphoid alveolitis in both irradiated and unirradiated lung fields.

Design: A prospective, nonrandomized study.

Patients: Women receiving postoperative radiotherapy for carcinoma of the breast were evaluated both before and 4 to 6 weeks after radiotherapy. Findings after radiotherapy in 15 asymptomatic patients were compared with findings in a group of patients with clinical radiation pneumonitis.

Measurements: History, physical examination, chest radiograph, quantitative gallium lung scanning, respiratory function tests, bronchoalveolar lavage, and lavage lymphocyte subset analysis.

Results: After irradiation, lavage lymphocytes increased significantly (34.5% versus 46.8%; P = 0.01) in the 17 patients studied prospectively. There was an associated reduction in vital capacity (102.5% versus 95.5%; P = 0.04). Comparison of results in patients before treatment, after treatment without clinical pneumonitis, and after treatment with clinical pneumonitis showed a dramatic increase in total lymphocytes after irradiation (6.3 versus 9.4 versus 35.2 million, respectively; P = 0.005), particularly in those with clinical pneumonitis. Only in those with clinical pneumonitis was this accompanied by an increase in the gallium index (3.7 versus 3.4 versus 9.0, respectively; P < 0.001). Vital capacity was also progressively reduced (102.5% versus 96.9% versus 76.7%, respectively; P = 0.04), as was diffusing capacity (98.6% versus 91.4% versus 72.6%, respectively; P = 0.003). No statistical differences existed between irradiated and unirradiated sides of the chest in either lavage or gallium lung scan studies.

Conclusion: In most patients, a lymphocytic alveolitis develops in both lung fields after strictly unilateral thoracic irradiation; this is more pronounced in patients developing clinical pneumonitis. These findings suggest that radiotherapy may cause a generalized lymphocyte-mediated hypersensitivity reaction.


Grahic Jump Location
Figure 1.
Flow cytometric analysis.

Comparison of lavage lymphocytes from one patient with clinical radiation pneumonitis and two controls. These cells have been labeled with control monoclonal antibody, and antibodies to all T cells (CD3), helper T cells (CD4), suppressor/cytotoxic T cells (CD8), NK cells (CD56), two isoforms of tyrosine phosphatase (CD45RA and CD 45RO), and T-cell activation markers HLA DR, CD25 (interleukin-2 receptor), CD38, and CD69.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.