Pneumothorax following induction chemotherapy in patients with lung metastases: A case report and literature review

Abstract

A 29-year-old patient presented with bilateral pulmonary lesions following surgery for recurrent placental site trophoblastic tumor (PSTT). On day seven after institution of the 'EMA' regimen (etoposide, medium dose methotrexate with folinic acid rescue and actinomycin-D), complete pneumothorax occurred. Closed-system air drainage brought only transient lung expansion and subsequent talc pleurodesis was needed. During follow-up, complete regression of lung metastases was observed. A literature survey of post-chemotherapy pneumothorax in patients with lung metastases disclosed fourteen hitherto reported cases. Including the present PSTT case, non-epithelial gynecologic malignancy (3 patients) ranks second to osteogenic sarcoma (6 cases) with regard to the primary tumor involved.

Cisplatin-based chemotherapy in advanced seminoma: Experience of the Northern Israel Oncology Center: 1981–1994

“…4) developed spontaneous pneumothorax (SP) a few days after the first treatment. SP complicating chemotherapy has been reported mainly in chemosensitive metastatic tumors, such as osteogenic sarcoma, Wilms' tumor, and small cell lung carcinoma [18]. Only one patient with metastatic seminoma developing SP has been reported to date [19].…”

“…Only one patient with metastatic seminoma developing SP has been reported to date [19]. The proposed pathophysiological mechanisms for SP complicating chemotherapy are related to rapid rupture of chemosensitive and peripherally (subpleural) located nodules with subsequent bronchopleural fistula, previous radiation to the lung, chemotherapy-induced lysis and impaired repair process, and increased intrathoracic pressure following emetogenic chemotherapy, particularly cisplatin [18,[20][21][22].…”

Spontaneous Pneumothorax During Chemotherapy: A Case Report

“…Sarcomas,mainlyosteosarcomas,appeartobethemalignancy most often associated with SP [1,2]. Apart from sarcomas, thiscomplicationhasalsobeenreportedinpatientswithlung metastasesfrommalignanciessuchasgermlinetumours,nonepithelialgynaecologicalmalignancies,insomepatientswith lymphomas and small-cell lung cancer.…”

Simultaneous bilateral spontaneous pneumothorax following high-dose chemotherapy and bone marrow transplantation for mantle cell lymphoma without evidence of pulmonary disease

“…The majority of cases had known lung lesion metastases or had a detectable lung lesion noted shortly after the SBSP occurred. The phenomenon has been reported in cases of metastatic sarcoma, trophoblastic tumor, non-seminomatous testicular cancer, and non-Hodgkin lymphoma [3][4][5][6][7][8][9][10] Sarcoma is most commonly associated with SBSP. One review examining 15 cases of SP after treatment with chemotherapy found an average time to develop SP after initiation of chemotherapy was 2-23 days [7].…”

“…Several concepts have been proposed, including rupture of underlying coexistent emphysematous bullae; the presence of a cavitating tumor; a ball-valve effect of a tumor resulting in hyperinflation of alveoli; impaired healing in lung; tumor lysis or necrosis creating a bronchopleural fistula; and persistent local infection [5,7,11]. Biran et al [7] observed that certain chemotherapy regimens have higher rates of SP in some malignancies and theorized that the occurrence of an SP reflects a higher degree of activity of that drug against that particular tumor.…”