Early diagnosis and treatment of secondary lung damage in children with malignant brain tumors after radiation therapy

Objective To investigate the early diagnosis and treatment of craniospinal irradiation(CSI) induced lung injury (RILI) in children with malignant brain tumors. Methods From January 2014 to January 2016, a total of 145 children with malignant brain tumors from Beijing Shijitan Hospital, Capital Medical University were enrolled in this study.All children received postoperative CSI.Ten children were diagnosed as RILI by high-resolution computed tomography (HRCT) scanning before the start of subsequent chemotherapy and 42 days after CSI.Oral Prednisone acetate tablets 0.5-1.0 mg/(kg·d) were given to treat RILI and compound Sulfamethoxazole to prevent secondary lung inflammation.Antibiotic treatment and symptomatic support were given to 2 patients because of the combined infection.Then every 4 weeks HRCT was performed and the dosage of Prednisone was adjusted.Clinical characteristics and treatment effects were observed synthetically. Results Up to January 2018, the median follow-up time was 28 months (ranged from 26 to 48 months), only 10 patients suffered from RILI, and the morbidity was 6.9%.Eight of 10 patients had medulloblastoma, 1 case with pineoblastoma, and 1 case with atypical teratoma/rhabdomyoid tumor.They were 6 boys and 4 girls, and the median age was 8 years old (ranged from 5 to 13 years old). The time points of diagnosis of lung damage were 39-52 days after the end of radiotherapy, and lesions were located in the dorsal or basal segments of lower lobe of unilateral or bilateral lung in HRCT scanning.No obvious respiratory symptoms or other discomfort was found except for frequent cough in 2 patients.Lung lesions were gradually reduced and disappeared within 2 to 8 months after treatment with Prednisone and compound Sulfamethoxazole.Two cases suffered severe infection before or during the subsequent chemotherapy, and the condition was gradually improved after anti-infection treatment based on drug sensitivity test.Then subsequent chemotherapy underwent successfully. Conclusions RILI presents mild symptoms or asymptomatic.Routine lung imaging after radiotherapy is beneficial to the early diagnosis of lung damage, and early treatment with Prednisone and prophylaxis with compound Sulfamethoxazole has a good prognosis. Key words: Child; Brain tumor; Craniospinal irradiation; Radiation induced lung injury