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[Radiologic characteristics of the thorax during therapy with interleukin-2]
S Morassut1, L Balestreri, E Galligioni
1Servizio di Radiologia, Centro Regionale di Riferimento Oncologico, Aviano, Pordenone.
Insights
Interleukin-2 (IL-2) therapy for cancer can cause vascular leak syndrome, leading to pulmonary edema and effusions. Chest X-rays effectively detect early signs, allowing for dose adjustments and preventing severe respiratory distress.
Area of Science:
- Immunology
- Oncology
- Radiology
Background:
- Interleukin-2 (IL-2) is a cytokine produced by lymphocytes that activates natural killer cells for anti-tumor activity.
- IL-2 demonstrates clinical efficacy in treating melanoma and renal cell carcinoma metastases.
- A major dose-limiting toxicity of IL-2 is Vascular Leak Syndrome (VLS), characterized by pulmonary edema and effusions.
Purpose of the Study:
- To evaluate the utility of chest radiographs in detecting early signs of VLS during IL-2 therapy.
- To identify specific radiographic findings indicative of VLS in patients receiving IL-2 for metastatic cancer.
Main Methods:
- A retrospective analysis of chest radiographs from 43 patients treated with IL-2 for melanoma and renal cell carcinoma metastases.
- Radiographs were assessed for pulmonary edema, pleural effusions, and pericardial effusions.
Main Results:
- Pulmonary edema was observed in 60% of patients.
- Bilateral pleural effusions occurred in 32% of patients.
- Pericardial effusions were present in 27% of patients.
Conclusions:
- Daily chest radiography can detect early-stage VLS during IL-2 treatment.
- Early detection enables optimal IL-2 dosing and timely intervention to prevent respiratory complications.
Abstract:
Interleukin-2 is a glycoprotein physiologically produced by human lymphocytes which is capable of mediating some still unknown immunologic reactions. In vitro, interleukin-2 was seen to induce a lytic reaction against tumor cells through the activation of a cytolytic system of natural killer cells. If administered to man in heavy doses, it causes a clinical response in the treatment of metastases from melanoma and renal cell carcinoma in 20-40% of cases. However, the clinical use of the drug, in therapeutic doses, is prevented by the occurrence of several side-effects, the major one being increased permeability of alveolar vessels with capillary leak and interstitial pulmonary edema (Vascular Leak Syndrome in the English literature). Thus, this work was aimed at evaluating chest radiographs during interleukin-2 treatment to detect, in the pulmonary district, the early stages of the vascular leak syndrome--i.e., pulmonary edema, pleural and pericardial effusions. Forty-three patients had been treated for metastases from renal cell carcinoma and melanoma November 1989 through September 1991: standard chest radiographs demonstrated 26 cases (60%) of pulmonary edema, 14 cases (32%) of bilateral pleural effusions and 12 cases (27%) of pericardial effusions. Daily chest films of the patients undergoing interleukin-2 therapy allowed the early stage of the vascular leak syndrome to be depicted, thus enabling the physician to use the highest tolerated doses and eventually to stop infusion before marked respiratory distress develops.