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Post-radiotherapy maintenance treatment with fluticasone propionate and salmeterol for lung cancer patients with grade III radiation pneumonitis: A case report.

Abstract This combination of fluticasone propionate (FP) and the long-acting β2-agonist salmeterol (Salm) can control the symptoms of asthma and COPD better than FP or Salm on their own and better than the combination of inhaled corticosteroids plus montelukast. FP/Salm has been shown to control symptoms of asthma and COPD better than a double dose of inhaled steroids. The patient in our report had a history of COPD, and suffered relapse of RP when given only steroids. It is possible that COPD history helps explain this patient's more difficult treatment course. Therefore, this combination may be more effective than inhaled steroids for patients with a history of COPD.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29794744
OWN - NLM
STAT- MEDLINE
DCOM- 20180612
LR  - 20180612
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 21
DP  - 2018 May
TI  - Post-radiotherapy maintenance treatment with fluticasone propionate and
      salmeterol for lung cancer patients with grade III radiation pneumonitis: A case 
      report.
PG  - e10681
LID - 10.1097/MD.0000000000010681 [doi]
AB  - RATIONALE: This combination of fluticasone propionate (FP) and the long-acting
      beta2-agonist salmeterol (Salm) can control the symptoms of asthma and COPD
      better than FP or Salm on their own and better than the combination of inhaled
      corticosteroids plus montelukast. FP/Salm has been shown to control symptoms of
      asthma and COPD better than a double dose of inhaled steroids. The patient in our
      report had a history of COPD, and suffered relapse of RP when given only
      steroids. It is possible that COPD history helps explain this patient's more
      difficult treatment course. Therefore, this combination may be more effective
      than inhaled steroids for patients with a history of COPD. PATIENT CONCERS: This 
      patient suffered adverse reactions triggered by methylprednisolone: weight gain, 
      hyperglycaemia and sleep disturbance after more than two months of intravenous
      and oral prednisolone. These reactions disappeared when we switched the patients 
      to FP/Salm maintenance therapy. DIAGNOSES: The patient underwent upper right
      lobectomy in September 2011. Immunohistochemistry indicated low squamous cell
      differentiation, and he was diagnosed with stage IIB disease (T2N1M0) according
      to the Union for International Cancer Control (UICC) (7th edition).One month
      after repeat radiotherapy, the patient experienced fever (37.6 degrees C), cough,
      chest distress and shortness of breath. We performed serologic tests, laboratory 
      tests for procalcitonin and C-reactive protein, as well as sputum and blood
      cultures to rule out bacterial infection. Chest CT showed consolidation with air 
      bronchogram in the hilum of the right lung and ground-glass densities in the
      right lower lobe and left upper lobe. These radiographic signs are typical of RP.
      Since the patient required oxygen, he was diagnosed with grade III RP.
      INTERVENTIONS: After the patinet was diagnosed with grade III RP. The patient was
      immediately prescribed oxygen, anti-infectives for prophylaxis, treatments to
      facilitate expectoration and prevent asthma, and most importantly, intravenous
      methylprednisone at an initial dose of 60 per day. And we cut the steroid dose in
      half every one week when the patient's symptoms improved obviously, and the
      patchy shadow on the chest radiograph sharply reduced. Then we give him FP (500
      mg)/Salm (50 mg) twice daily for two months. Then the dose was halved for an
      additional two months. OUTCOMES: The patient showed no signs of tumor or RP
      relapse by the last follow-up in March 2018. LESSONS: This maintenance therapy of
      FP/Salm for patient with grade III RP may help avoid relapse when steroid therapy
      is tapered, particularly for patients with a history of COPD. It may also reduce 
      risk of steroid-associated adverse effects. Based on the results observed with
      our patient, we intend to design a prospective trial to assess the efficacy of
      FP/Salm when used as preventive treatment for patients at high risk of RP, and
      when used as maintenance treatment for patients with grade III RP.
FAU - Zhang, Pingping
AU  - Zhang P
AD  - Department of Radiation Oncology.
FAU - Yan, Hongxia
AU  - Yan H
AD  - Department of Radiation Oncology.
FAU - Wang, Sheng
AU  - Wang S
AD  - Department of Surgical Oncology, Hubei Cancer Hospital, the Affiliated Hubei
      cancer Hospital of Huazhong University of Science and Technology, Wuhan, China.
FAU - Kai, Jindan
AU  - Kai J
AD  - Department of Surgical Oncology, Hubei Cancer Hospital, the Affiliated Hubei
      cancer Hospital of Huazhong University of Science and Technology, Wuhan, China.
FAU - Pi, Guoliang
AU  - Pi G
AD  - Department of Radiation Oncology.
FAU - Peng, Yi
AU  - Peng Y
AD  - Department of Radiation Oncology.
FAU - Liu, Xiyou
AU  - Liu X
AD  - Department of Radiation Oncology.
FAU - Sun, Junwei
AU  - Sun J
AD  - Department of Surgical Oncology, Hubei Cancer Hospital, the Affiliated Hubei
      cancer Hospital of Huazhong University of Science and Technology, Wuhan, China.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Adrenergic beta-2 Receptor Agonists)
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (Fluticasone-Salmeterol Drug Combination)
RN  - 0 (Glucocorticoids)
RN  - X4W7ZR7023 (Methylprednisolone)
SB  - AIM
SB  - IM
MH  - Adrenergic beta-2 Receptor Agonists/*therapeutic use
MH  - Anti-Inflammatory Agents/*therapeutic use
MH  - Fluticasone-Salmeterol Drug Combination/*therapeutic use
MH  - Glucocorticoids/adverse effects/therapeutic use
MH  - Humans
MH  - Lung/pathology/radiation effects
MH  - Lung Neoplasms/*therapy
MH  - Male
MH  - Methylprednisolone/adverse effects/therapeutic use
MH  - Middle Aged
MH  - Pneumonectomy
MH  - Pulmonary Disease, Chronic Obstructive/complications/drug therapy
MH  - Radiation Pneumonitis/diagnosis/*drug therapy
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
EDAT- 2018/05/26 06:00
MHDA- 2018/06/13 06:00
CRDT- 2018/05/26 06:00
PHST- 2018/05/26 06:00 [entrez]
PHST- 2018/05/26 06:00 [pubmed]
PHST- 2018/06/13 06:00 [medline]
AID - 10.1097/MD.0000000000010681 [doi]
AID - 00005792-201805250-00020 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(21):e10681. doi: 10.1097/MD.0000000000010681.