Interstitial pulmonary infiltrate following combined therapy for esophageal carcinoma

Seven patients with squamous cell carcinoma of the esophagus received radiation therapy in twice weekly 400 rad fractions over five weeks followed by esophagectomy. Four of these patients developed severe interstitial pulmonary infiltrates and died of pulmonary insufficiency 18-50 days after surgery. In three of these patients the infiltrates were detected within 24 hours of surgery while the infiltrate was not present until the eighth postoperative day in the fourth patient. Postmortem examination revealed widespread dilatation of interstitial and subpleural lymphatics. It is postulated that the combination of large fraction radiation therapy followed by extensive surgery resulted in lymphatic obstruction.