Radiation pneumonitis in a patient exposed to asbestos

Our plain-English summary of Radiation pneumonitis in a patient exposed to asbestos, by R.F. Ashford, J. Maher, A. Drury, et al (The British Journal of Radiology, 1981).

The study

• Authors: R.F. Ashford, J. Maher, A. Drury, D. Pickering
• Journal: The British Journal of Radiology
• Published: 1981;54(637):74-7
• Type of article: Case report
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002010).

In plain English

This case report from Westminster Hospital, London, described a 58-year-old man given radiotherapy for squamous cell carcinoma of the oesophagus. For many years he had run an asbestos importing and fibreizing plant, and pre-treatment chest X-rays showed pleural plaques. He received 5400 cGy of cobalt-60 gamma rays to the whole oesophagus over 37 days. The calculated lung dose within the treatment fields was at least 3600 cGy. Four months later, X-rays showed extensive shadowing in both lungs, bounded by the edges of the treatment fields, which the authors said strongly suggested radiation pneumonitis. Lung function tests showed a restrictive defect. Nine months after treatment the pneumonitis had completely resolved. He died after a tracheo-oesophageal fistula developed. At autopsy, asbestos bodies were found in many alveoli, with subpleural fibrosis typical of asbestos exposure, but there was no pulmonary interstitial fibrosis or radiation change. The authors acknowledged that coincidence was possible. They thought it more likely that the asbestos bodies magnified the effect of radiation, and concluded that asbestosis could be another factor that may contribute to radiation pneumonitis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 58-year-old man referred to the Stanford Cade Department of Clinical Oncology, Westminster Hospital, London, for radiotherapy to a squamous cell carcinoma of the middle third of the oesophagus. He also had hypertension, gout, a past myocardial infarct and atrial fibrillation. He smoked and drank to excess, and had presumed alcoholic cirrhosis.
• Exposure: Asbestos exposure (fiber type not stated) from running an asbestos importing and fibreizing plant for many years, with pleural plaques on pre-treatment chest X-rays. He was then irradiated with 5400 cGy cobalt-60 gamma rays to the whole oesophagus over 37 days by a three-field technique. The calculated lung dose within the fields was 3600 cGy at minimum; the maximum is printed unclearly in the scanned text.
• Main results:
  • A chest X-ray four months after radiotherapy showed extensive diffuse shadowing in both lungs, bounded by the margins of the treatment fields. The authors said this strongly suggested radiation pneumonitis.
  • Lung function tests in this patient showed a vital capacity of 2.36 litres (predicted 4.47) and FEV of 1.61 litres (predicted 3.43), consistent with a restrictive lung defect.
  • Nine months after radiotherapy, when his swallowing difficulty returned, a chest X-ray showed complete resolution of the pneumonitis.
  • At autopsy, asbestos bodies associated with macrophages were found in many alveoli, along with areas of subpleural fibrosis typical of asbestos exposure. There was no pulmonary interstitial fibrosis and no evidence of radiation change.
  • The authors reported that this was the most florid case of radiation pneumonitis seen in their department for some years. They had not seen pneumonitis in other patients treated for oesophageal carcinoma with this three-field technique.
• The authors' conclusion: The authors concluded that asbestosis could be another factor that may contribute to radiation pneumonitis. They judged it more likely that asbestos bodies in the alveoli magnified the effect of irradiation than that the case was a coincidence.
• Limitations the authors state:
  • The authors acknowledged that the occurrence of pneumonitis in this asbestos-exposed patient could be a coincidence.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Throat and laryngeal cancer.

Medical terms in this study, explained in our Lexicon: Pneumonitis.

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