Late follow-up of lung function after whole lung irradiation for Wilms' tumour

Abstract

Radiotherapy is known to have acute and long term deleterious effects on lung tissue. However, pulmonary irradiation is an established treatment in advanced childhood tumours with pulmonary metastases not responsive to chemotherapy. In this study eight patients with Wilms' tumours and lung metastases treated with whole lung irradiation (1200-1837 cGy) and chemotherapy were reassessed clinically, radiologically and with lung function tests 6-26 years after radiotherapy. One patient was breathless after mild exertion, four after strenuous exercise and three were asymptomatic. Clinically all had small chests and four of five females had underdeveloped breasts. A chest radiograph showed clear lung fields in all cases. Lung volumes, especially total lung capacity (TLC) and vital capacity (VC), were decreased when compared with predicted values for age and height. However, gas transfer per unit lung volume (KCO) was normal. This study suggests that pulmonary irradiation in childhood results primarily in underdevelopment of the thorax and that diffuse interstitial lung fibrosis is not a significant feature at this dose level.

Whole Lung Irradiation in Patients with Exclusively Pulmonary Metastases of Ewing Tumors

“…However, a bias between both groups cannot be excluded. The presented results are in concordance with other reports presenting late follow-up data of small patient collectives after WLI [2,8,24]. Severe pneumonitis as radiation recall has also been reported after whole lung irradiation followed by epirubicin [16] as well as after thoracic radiotherapy following gemcitabine chemotherapy [22].…”

Pulmonary Outcomes in Survivors of Childhood Cancer

“…12,14 The diffusing capacity of the lung for carbon monoxide (D lco ) may also be reduced. 12 In 1992, Attard-Montalto et al 20 described lung function in eight survivors of Wilms tumor (follow-up, 14.8 years) who had received whole-lung irradiation at 15.3 Ϯ 1.8 gray (Gy) in 10 to 14 daily fractions , and actinomycin, a radiomimetic chemotherapeutic agent. These children demonstrated small lung volumes but normal gas transfer per unit lung volume (lung diffusion capacity corrected for alveolar ventilation) when compared with predicted values for age and height.…”

Late Effects of Thoracic Irradiation in Children

“…Surviving individuals are at risk of developing late effects after their antitumor therapy including surgery, radiation therapy, or chemotherapy [4,7,8,14,16,20]. Radiotherapy as part of this multimodal treatment approach is an important treatment strategy for many malignancies in pediatric oncology [37,42,43].…”