Seven patients developed a lung abscess and bronchopleural fistula after undergoing aggressive treatment of their lung cancer with radiotherapy +/- chemotherapy. These complications were preceded by a prodrome of recurrent bronchitis with increasing refractoriness to antibiotics, weight loss, fever, and generalized debilitation. Delays in definitive diagnosis and treatment often resulted from concern about the patients guarded cancer prognosis and misinterpretation of involved areas on x-rays and scans as being secondary to cancer rather than manifestations of treatment toxicity. Early surgical treatment utilizing local muscular flaps for bronchial stump reinforcement and restoration of chest wall continuity can successfully remedy these complications.
A total of 211 patients with limited small cell lung cancer were assessed retrospectively for long-term toxicities, treatment-related deaths, and second primaries. All had received treatment with various combinations of doxorubicin, vincristine, cisplatin, lomustine, cyclophosphamide, and etoposide with or without split-course thoracic radiotherapy (4,000 cGy/10 fractions) and/or split-course prophylactic cranial irradiation (3,600 cGy/10 fractions). Sixty-eight (32%) of the patients survived longer than 1.5 years and formed the basis of this study. Debilitating pulmonary, cardiac, and neurologic toxicity was noted in 12%, 14%, and 15%, respectively, of long-term survivors. These complications were the result of aggressive combined modality therapy. Certain drugs appeared to cause additive toxicity when combined with radiation. Three patients developed new primary tumors of squamous cell origin. Attention must be directed to defining the safest way to employ aggressive combined modality treatment for these patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.