Exacerbation of gemcitabine-related pneumonia during radiotherapy for extrapulmonary lesion

Late-onset gemcitabine pulmonary toxicity is rare and association between pulmonary toxicity and radiotherapy to the extrapulmonary sites is controversial. Here, we report a case of acute exacerbated fatal interstitial pneumonia during radiotherapy to the extrapulmonary site. A 73-year-old woman with pelvic lymph node metastases from urothelial carcinoma underwent palliative radiotherapy after failure of gemcitabine-containing and gemcitabine-non-containing chemotherapy. Gemcitabine-containing chemotherapy had finished 13 months prior to the radiotherapy due to grade 3 pulmonary toxicity. During the course of radiotherapy to the pelvic lesion, she was complicated with fatal acute interstitial pneumonia even though the lung tissue was not irradiated. To the best of our knowledge, this is the first reported case of fatal gemcitabine-related pulmonary toxicity during radiotherapy for extrapulmonary lesion. Although the association between late-onset pulmonary toxicity and radiotherapy is controversial, caution should be paid to a patient with a history of gemcitabine-related pulmonary toxicity who will undergo radiotherapy even though the lung volume is not irradiated.