Pneumothorax following induction chemotherapy for a germ cell tumour

Laurencet, F; Zulian, Gilbert; Dietrich, Pierre‐Yves

doi:10.1016/s0959-8049(96)00296-1

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…The pathophysiologic mechanisms of pneumothorax in the setting of treating a pulmonary malignancy are not known, but may include fistula formation between the lung parenchyma and pleural space due to necrosis of a subpleural tumor nodule, infarction and necrosis of tumor emboli, over distension and subsequent rupture of alveoli due to tumor progression, and increased intrathoracic pressure following emetogenic chemotherapy. [ 19 – 21 , 24 , 28 , 29 ] In the case of antiangiogenesis treatment, sorafenib and bevacizumab both work by blocking VEGF signaling either by VEGFR tyrosine kinase inhibitor (sorafenib) or recombinant humanized anti-VEGF monoclonal antibody (bevacizumab), thereby disrupting the vascular architecture of the tumor-burdened tissue. Within this context, one can hypothesize that the use of VEGF blockers in combination with antiproliferative chemotherapy produces pulmonary nodule necrosis secondary to vascular perfusion compromise, subsequent rupture and pathologic pneumothorax formation.…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors

Interiano¹,

McCarville²,

Wu³

et al. 2015

Journal of Pediatric Surgery

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Purpose Antiangiogenic agents show significant antitumor activity against various tumor types. In a study evaluating the combination of sorafenib, bevacizumab, and low-dose cyclophosphamide in children with solid tumors, an unexpectedly high incidence of pneumothorax was observed. We evaluated patient characteristics and risk factors for the development of pneumothorax in patients receiving this therapy. Patients and Methods Demographics, clinical course, and radiographic data of 44 patients treated with sorafenib, bevacizumab and cyclophosphamide were reviewed. Risk factors associated with the development of pneumothorax were analyzed. Results Pneumothorax likely related to study therapy developed in 11 of 44 (25%) patients of whom 33 had pulmonary abnormalities. Median age of patients was 14.7 years (range, 1.08–24.5). Histologies associated with pneumothorax included rhabdoid tumor, synovial sarcoma, osteosarcoma, Ewing sarcoma, Wilms tumor, and renal cell carcinoma. Cavitation of pulmonary nodules in response to therapy was associated with pneumothorax development (P<0.001). Median time from start of therapy to development of pneumothorax was 5.7 weeks (range, 2.4–31). Conclusion The development of cavitary pulmonary nodules in response to therapy is a risk factor for pneumothorax. As pneumothorax is a potentially life-threatening complication of antiangiogenic therapy in children with solid tumors, its risk needs to be evaluated when considering this therapy.

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Section: Discussionmentioning

confidence: 99%

Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors

Interiano¹,

McCarville²,

Wu³

et al. 2015

Journal of Pediatric Surgery

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“…Other speculative contributing mechanisms include increased intrathoracic pressure following emetogenic chemotherapy, especially cisplatin, and the defective repair process induced by adriamycin. 3,8 Our patient was a nonsmoker who had no previous history of spontaneous pneumothorax and, although proof of the relationship between the pneumothorax and the effect of chemotherapy is not conclusive, the lack of any other known case or pertinent history, and the temporal relationship to chemotherapy and to its response make this etiology likely. In fact, the occurrence of recidivant SSP in our patient is strongly considered to be related to the radiologic regression of the metastases resulting from chemotherapy.…”

Section: Discussionmentioning

confidence: 86%

“…These included 7 patients with osteogenic sarcoma, 7 with germinal tumors, 3 with uterine leiomyosarcoma, 2 with endometrial carcinoma, 2 with synovial cell sarcoma, 2 with lymphoma, and 1 each with Wilm's tumor, thymoma, small cell lung cancer, adenocarcinoma from an unknown primary, and breast cancer. [3][4][5][6][7][8] The actual mechanism of the complicating pneumothorax in primary and metastatic lung cancer is not completely understood, but the pathophysiology would depend on the particular tumor involved. For example, in primary lung cancer the SSP may be produced either by the pathological lung abnormalities that occur secondary to smoking, or by progression of the tumor, causing rupture of an ischemic primary lesion into the pleural space.…”

Section: Discussionmentioning

confidence: 99%

Bilateral recurrent pneumothorax complicating chemotherapy for pulmonary metastatic breast ductal carcinoma: Report of a case

et al. 2000

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Secondary spontaneous pneumothorax (SSP) is a rare complication of chemotherapy for pulmonary metastases and to the best of our knowledge, only 28 cases have been described, most of which occurred in patients with osteosarcoma or germ cell tumors. We present herein the case of a 56-year-old woman in whom bilateral and recurrent SSP was caused by the rupture of pulmonary lacunae induced by chemotherapy, given for bilateral lung metastases secondary to breast carcinoma. Our experience of this case led us to conclude that: patients with pulmonary metastases may develop bilateral and/or recurrent pneumothoraces following chemotherapy; computed tomography scan is essential for defining the cause of SSP; and closed chest tube drainage remains the therapy of choice, while chemical pleurodesis may also be used to prevent recidivant SSP.

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“…Specifically, it is thought that some peripheral, subpleural nodules are particularly chemosensitive, leading to rapid lysis and necrosis after treatment with chemotherapy. The eventual rupture of these nodules results in leakage of air into the pleural space, producing a pneumothorax [ 12 , 13 ]. Another mechanism that has been proposed includes the use of emetogenic chemotherapy agents.…”

Section: Discussionmentioning

confidence: 99%

Recurrent spontaneous pneumothoraxes as a complication of osteosarcoma metastases: a case report

Kleedehn

Kovács

Fitzpatrick

2021

Radiology Case Reports

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Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. Osteosarcomas are highly aggressive tumors that historically have had a dismal prognosis. However, the survival rate has improved significantly with the addition of adjuvant and neoadjuvant chemotherapy. Here, we present a case report of a 13-year-old male with a history of a left humeral osteosarcoma whose course was complicated by recurrent sarcoma-related pneumothoraces. Despite recurrent pneumothoraces being a relatively uncommon complication of osteosarcoma, they present a great challenge to providing treatment that optimizes outcomes and quality of life for patients.

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Pneumothorax following induction chemotherapy for a germ cell tumour

Cited by 6 publications

References 9 publications

Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors

Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors

Bilateral recurrent pneumothorax complicating chemotherapy for pulmonary metastatic breast ductal carcinoma: Report of a case

Recurrent spontaneous pneumothoraxes as a complication of osteosarcoma metastases: a case report

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