Expected and non-expected immune-related adverse events detectable by CT. Issue 138 (May 2021)

• Record Type: Journal Article
• Authors: Ciccarese, Federica; Piccinino, Alberto; Brocchi, Stefano; Balacchi, Caterina; Dall'Olio, Filippo Gustavo; Massari, Francesco; Rihawi, Karim; Paccapelo, Alexandro; Ardizzoni, Andrea; Golfieri, Rita
• Is Part Of: European journal of radiology. Issue 138(2021)
• Publication Date: 2021-05
• Subjects: Immune-related adverse events -- CT -- Interstitial lung disease -- Pneumonitis -- Transient asymptomatic pulmonary opacity; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109617
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Immune-related adverse events detectable by CT occurred in 19.4 % of patients. ILD classification does not cover all drug-related pulmonary toxicities. Additional findings were: TAPOs, radiation recall pneumonia, sarcoid-like reaction. Abdominal complications included colitis, cholecystitis, pancreatitis, ischemia. Abstract: Purpose: Cancer treatments with immune checkpoint inhibitors (ICI) are associated with a unique set of drug toxicities called immune-related adverse events (irAES). The aim of the present study was to describe the radiological manifestation of irAES detectable by CT. Method: Retrospective analysis of 284 patients treated with ICI for various types of advanced cancer; of them, 129 patients were selected, all having been treated with single-agent ICI, and all with a baseline CT scan and follow-up scans available at our Institute. CT examinations were reviewed by two radiologists involved in the study with a consensus reading. Imaging findings consistent with irAES were reported and correlated with clinical-laboratory data. Results: Immune-related adverse events were found in 25/129 (19.4 %) patients. No statistically significant differences were found in either the prevalence of irAES or in the time of onset of tumour type. Thoracic complications were detected in 14/25 (56.0 %) patients consisting in: 3 radiation recall pneumonia, 3 Transient Asymptomatic Pulmonary Opacities (TAPOs), 3 hypersensitivity pneumonia, 2 diffuse alveolar damage, 2 organizing pneumonia, 1 sarcoid-like reaction. In the remaining 11/25 (44.0 %), there were extra-pulmonary complications: 3 colitis, 4 cholecystitis, 2 pancreatitis and 2 cases of visceral ischemia. Conclusions: Radiologists should be aware of the wide spectrum of irAES as they could affect the outcome. Pneumonia is the most frequent irAES; however, the international classification for interstitial lung disease does not seem to be capable of describing all possible drug-related pulmonary toxicities. Additional findings included TAPOs, radiation recall pneumonia and sarcoid-like reaction.