Bleomycin lung toxicity detected by technetium-99m diethylene triamine penta-acetic acid aerosol scintigraphy

Abstract

In this study we investigated bleomycin-induced pulmonary toxicity in patients with germ-cell tumour by means of technetium-99m diethylene triamine penta-acetic acid aerosol scintigraphy. Twenty untreated patients who had no clinical or radiological evidence of pulmonary disease received four courses of etoposide, cisplatin and bleomycin chemotherapy. Aerosol lung scintigraphy and pulmonary function tests were performed in all patients before bleomycin treatment and after administration of 180 and 360 mg bleomycin. On the basis of the scintigrams the percentage decline in activity per minute (Kep) was evaluated, which represented an accurate parameter of lung membrane permeability. Pretreatment Kep values (0.891 +/- 0.286) were significantly lower than those obtained following 180 and 360 mg bleomycin treatment (1.176 +/- 0.336 and 1.389 +/- 0.477, respectively; P < 0.0005). The Kep values obtained with 180 and 360 mg bleomycin treatments were also significantly different (P < 0.005). In contrast, no significant change was observed in the results of pulmonary function tests. Our results demonstrate that evaluation of the pulmonary clearance of 99mTc-DTPA represents a useful means of monitoring the functional status of the lung epithelial membrane during bleomycin treatment. Further prospective studies are needed to assess the relationship between increase in permeability and development of lung toxicity in order to decide which patients should discontinue bleomycin therapy.

Nuclear medicine in the monitoring of organ function and the detection of injury related to cancer therapy

“…The aerosol test was sensitive enough to detect changes at a cumulative dose of 180 mg bleomycin and the results suggested that the agents affect the lung in a patchy pattern [135]. The aerosol test was sensitive enough to detect changes at a cumulative dose of 180 mg bleomycin and the results suggested that the agents affect the lung in a patchy pattern [135].…”

The Use of Imaging in the Prediction and Assessment of Cancer Treatment Toxicity

“…Perfusion SPECT could be used to improve radiotherapy planning and reduce pulmonary radiotoxicity. Earlier studies with 99m Tc-DTPA aerosol inhalation planar lung scintigraphy had shown that there was a significantly shorter clearance time in patients with chemotherapy-induced pulmonary damage compared with their pretreatment state or to those who did not receive chemotherapy [ 17 , 18 ]. Petit et al hypothesized that pretreatment pulmonary inflammation renders the lung more susceptible to radiotoxicity [ 19 ].…”