Résumé
De nombreux agents incluant les substances cytotoxiques et non cytotoxiques peuvent entraîner une toxicité pulmonaire, qui concerne essentiellement le parenchyme et moins fréquemment les voies aériennes, la plèvre et la circulation sanguine pulmonaire. Les symptômes induits par la toxicitéde ces traitements sont peu spécifiques et peuvent être difficiles à distinguer de ceux provoqués par plusieurs pathologies survenant dans ce contexte de cancer en cours de traitement. Ainsi, le diagnostic est essentiellement réaliséaprès exclusion de toutes les autres causes possibles de pathologie pulmonaire, et repose aussi sur la relation temporelle entre l’exposition du médicament et le début des symptômes respiratoires. Les signes cliniques et radiologiques de ces traitements reflètent en général le processus histopathologique sousjacent et incluent la pneumopathie interstitielle non spécifique, les dommages alvéolaires diffus, la bronchiolite oblitérante avec organisation pneumonique (BOOP), l’œdème et l’hémorragie alvéolaire. De plus, plusieurs de ces traitements altèrent les tests fonctionnels respiratoires des patients. La connaissance de l’ensemble de ces signes et des traitements les plus fréquemment incriminés peut faciliter le diagnostic et l’initiation d’un traitement approprié. Pneumotox® (www.pneumotox.com) apporte une information régulièrement mise à jour sur les pathologies respiratoires iatrogènes.
Abstract
Numerous agents, including cytotoxic and non-cytotoxic drugs, may cause pulmonary toxicity, which involves mainly the lung parenchyma, and, less frequently, the airways, pleura and pulmonary circulation. Symptoms of drug-associated pulmonary toxicity are non-specific and can be difficult to distinguish from a number of disorders that commonly occur in cancer patients under treatment. Thus, diagnosis is mostly determined by excluding all other possible causes; it depends on the temporal association between the administration of the drug and the development of pulmonary toxicity. Clinical and radiological manifestations resulting from the use of these drugs generally reflect the underlying histopathological processes and include non-specific interstitial pneumonia, diffuse alveolar damage, bronchiolitis obliterans organizing pneumonia (BOOP), oedema and alveolar haemorrhage. Furthermore, a subset of these agents impairs pulmonary function. Knowledge of these manifestations and of the drugs most frequently involved can facilitate diagnosis and the determination of the most appropriate treatment. Pneumotox® (www. pneumotox.com) provides updated information on drug-induced respiratory disease.
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Taillade, L., Deplanque, G. Toxicité pulmonaire des traitements en oncologie. Oncologie 9 (Suppl 3), HS16–HS20 (2007). https://doi.org/10.1007/s10269-007-0743-9
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DOI: https://doi.org/10.1007/s10269-007-0743-9