Long-term pulmonary sequelae after treatment of childhood Hodgkin's disease

Bossi, Grazia; Cerveri, Isa; Volpini, E; Corsico, Angelo Guido; Baio, Ambrogia; Corbella, Franco; Klersy, Catherine

doi:10.1093/annonc/8.suppl_1.s19

Cited by 40 publications

(22 citation statements)

References 26 publications

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“…50% had one or more abnormalities in PFTs. 26 Similar data were reported in another study on a mixed cohort (15 ALL and 14 solid-tumor survivors), in which 48% had pulmonary function abnormalities. 15 In a study by Jenney et al 24 of lung function and exercise capacity in 70 survivors of childhood leukemia at a median of 6 years after diagnosis, .…”

Section: Alkylating Agents and Lung Dysfunctionsupporting

confidence: 82%

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Pulmonary Outcomes in Survivors of Childhood Cancer

Huang

Hudson

Stokes

et al. 2011

Chest

136

137

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O ver the last 3 decades, therapeutic progress has resulted in a growing population of survivors of childhood cancer. In 2006, there were Ͼ 11 million cancer survivors in the United States, three times the number of survivors in 1971. 1 The 5-year survival rate for children diagnosed with cancer is approaching 85%, 2 and an estimated one in 570 individuals in the United States between the ages of 20 and 34 is a survivor of childhood cancer. 3 Unfortunately, increased survival rates are not without consequences. There is substantial evidence Background: The purpose of this article is to summarize the literature that documents the longterm impact of cancer treatment modalities on pulmonary function among survivors of cancer and to identify potential areas for further research. Methods: Systematic reviews of clinical trials, observational studies, case series, and review articles were conducted. Articles were limited to the studies that discussed pulmonary toxicity or late effects among pediatric cancer survivors and to follow-up investigations that were conducted a minimum of 2 years after completion of cancer-related treatment or 1 year after hematopoietic stem cell transplant. Results: Sixty publications (51 clinical studies/reports and nine reviews) published from January 1970 to June 2010 in PubMed met the inclusion criteria. Data showed an association between radiotherapy, alkylating agents, bleomycin, hematopoietic stem cell transplant, and thoracic surgery and pulmonary toxicity, as well as possible interactions among these modalities. Conclusions: Pulmonary toxicity is a common long-term complication of exposure to certain anticancer therapies in childhood and can vary from subclinical to life threatening. Pulmonary function and associated loss of optimal exercise capacity may have adverse effects on long-term quality of life in survivors. Lung function diminishes as a function of normal aging, and the effects of early lung injury from cancer therapy may compound these changes. The information presented in this review is designed to provide a stimulus to promote both observational and interventional research that expands our knowledge and aids in the design of interventions to prevent or ameliorate pulmonary late effects among survivors of childhood cancer. CHEST 2011; 140(4):881-901Abbreviations: ALL 5 acute lymphoblastic leukemia; BCNU 5 carmustine; CCNU 5 lomustine; D lco 5 diffusing capacity of the lung for carbon monoxide; GVHD 5 graft-vs-host disease; gy 5 gray; HL 5 Hodgkin's lymphoma; HSCT 5 hematopoietic stem cell transplant; NHL 5 non-Hodgkin's lymphoma; PFT 5 pulmonary function testing; TLC 5 total lung capacity

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Section: Alkylating Agents and Lung Dysfunctionsupporting

confidence: 82%

“…Bossi et al 26 reported that children with HL who received mediastinal irradiation of . 20 Gy and higher cumulative doses of chemotherapy had a high risk of developing lung function abnormalities.…”

Section: Search Strategiesmentioning

confidence: 99%

Pulmonary Outcomes in Survivors of Childhood Cancer

Huang

Hudson

Stokes

et al. 2011

Chest

136

137

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“…5,6,19 Furthermore, increased occurrence of pulmonary abnormalities has been associated with dose-intensive protocols that include radiation therapy and/or high cumulative doses of chemotherapy in survivors of leukemia, 20 -22 rhabdomyosarcoma, 18 and Hodgkin disease [23][24][25] and in individuals who undergo bone marrow transplantation. 26,27 Based on self-reports, we identified a high incidence of significant pulmonary pathology, including lung fibrosis, pleurisy, and use of supplemental oxygen among childhood cancer survivors.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary complications in survivors of childhood and adolescent cancer

Mertens

Yasui

Liu

et al. 2002

Cancer

270

190

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BACKGROUNDThe Childhood Cancer Survivor Study is a resource that was designed to investigate long‐term effects among 5‐year survivors of childhood and adolescent malignancies. Previous studies have shown that exposure to chemotherapy and/or radiation can compromise pulmonary function in these survivors of childhood cancer.METHODSUsing information obtained from questionnaires from 12,390 childhood cancer survivors and 3546 randomly selected siblings, the authors evaluated the rate of first occurrence of 15 selected pulmonary conditions in three periods: during therapy, from the end of therapy to 5 years postdiagnosis, and ≥ 5 years postdiagnosis. Multivariate analyses were used to determine the relative risks with 95% confidence intervals of reported pulmonary conditions by exposure to the following treatment variables: radiation therapy to the chest, bleomycin, cyclophosphamide, busulfan, lomustine (CCNU), and/or carmustine (BCNU).RESULTSCompared with siblings, survivors had a statistically significant increased relative risk (RR) of lung fibrosis, recurrent pneumonia, chronic cough, pleurisy, use of supplemental oxygen, abnormal chest wall, exercise‐induced shortness of breath, bronchitis, recurrent sinus infection, and tonsillitis for all three periods. During the period of ≥ 5 years postdiagnosis, statistically significant associations were present for lung fibrosis and chest radiation (RR, 4.3; P = 0 001); for supplemental oxygen use and chest radiation (RR, 1.8; P < 0.001), BCNU (RR, 1.4; P = 0.05), bleomycin (RR, 1.7; P = 0.001), busulfan (RR, 3.2; P = 0.002), CCNU (RR, 2.1; P < 0.001), and cyclophosphamide (RR, 1.5; P = 0.01); for recurrent pneumonia and chest radiation (RR, 2.2; P = 0.001) and cyclophosphamide (RR, 1.6; P = 0.04); for chronic cough and chest radiation (RR, 2.0; P < 0.001), bleomycin (RR, 1.9; P < 0.001), and cyclophosphamide (RR, 1.3; P = 0.004); and for pleurisy and chest radiation (RR, 1.4; P = 0.02) and busulfan (RR, 5.1; P = 0.02). Chest radiation was associated with a 3.5% cumulative incidence of lung fibrosis at 20 years after diagnosis.CONCLUSIONSFor self‐report of pulmonary conditions, treatment‐related factors that continue to manifest > 5 years after diagnosis and treatment are important determinants of risk. Continued follow‐up of childhood cancer survivors is needed to evaluate the impact of pulmonary conditions on quality of life. Cancer 2002;95:2431–41. © 2002 American Cancer Society.DOI 10.1002/cncr.10978

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“…Pulmonary function can also be compromised by anticancer therapy, as reported in survivors of childhood leukemia (92,161,199), rhabdomyosarcoma (95), and Hodgkin disease (16,125,130), and in children treated with hematopoietic stem cell transplantation (23, 53). The lung is sensitive to both radiation and chemotherapy (1).…”

Section: Pulmonary Abnormalitiesmentioning

confidence: 99%

Adverse Late Effects of Childhood Cancer and Its Treatment on Health and Performance

Ness

Gurney

2007

Annu. Rev. Public Health

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More than 12,000 newly diagnosed cases of cancer occur each year in the United States among children ages 20 years or younger, and the current 5-year survival rate is near 80%. An estimated 228,000 among adults 47 years or younger and currently living in the United States had a diagnosis of cancer during childhood or adolescence. Here, we review long-term adverse effects of childhood cancer and its treatment with an emphasis on physical performance and health. We also briefly review existing guidelines that may be used to develop appropriate exercise and diet interventions for childhood cancer survivors. We suggest that there is a need for development of evidencebased, risk-based guidelines and interventions for health promotion among long-term childhood cancer survivors, particularly for those whose physical activity limitations interfere with chances for optimizing their bodies' potential in today's society.

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Long-term pulmonary sequelae after treatment of childhood Hodgkin's disease

Cited by 40 publications

References 26 publications

Pulmonary Outcomes in Survivors of Childhood Cancer

Pulmonary Outcomes in Survivors of Childhood Cancer

Pulmonary complications in survivors of childhood and adolescent cancer

Adverse Late Effects of Childhood Cancer and Its Treatment on Health and Performance

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