Prospective study of long-term pulmonary manifestations of mantle irradiation

Shapiro, Susan J.; Shapiro, Steven D.; Mill, William B.; Campbell, Edward J.

doi:10.1016/0360-3016(90)90500-j

Cited by 66 publications

(19 citation statements)

References 25 publications

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“…The potential pulmonary toxicity of chest irradiation has long been recognized (19), and the hazard of enhanced pulmonary toxicity induced by the combination of bleomycin and radiotherapy has extensively been analyzed (20). In our cohort, 8% of patients developed late mediastinal and/or pulmonary fibrotic complications with a pulmonary restrictive syndrome; in none of them did the cumulative dose of bleomycin exceed 100 mg, and in only one case was documented a lung lesion, suggesting bleomycin toxicity.…”

Section: Discussionmentioning

confidence: 80%

Long-term Events in Adult Patients with Clinical Stage IA-IIA Nonbulky Hodgkin's Lymphoma Treated with Four Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine and Adjuvant Radiotherapy: A Single-Institution 15-Year Follow-up

Brusamolino¹,

Baio

Orlandi³

et al. 2006

Clinical Cancer Research

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Purpose: To report on long-term events after short doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy and adjuvant radiotherapy in favorable early-stage Hodgkin's lymphoma. Experimental Design: We monitored late events and causes of death over 15 years (median follow-up, 120 months) in 120 patients with nonbulky stage IA-IIA Hodgkin's lymphoma, treated with four cycles of ABVD and limited radiotherapy. Pulmonary and cardiac function tests were done throughout the follow-up. Outcome measures included cause-specific mortality, standardized mortality ratio, and standardized incidence ratio for secondary neoplasia. Results: Projected 15-year event-free and overall survival were 78% and 86%, and tumor mortality was 3%. Standardized mortality ratio was significantly higher than 1 for both males (2.8; P = 0.029) and females (9.4; P = 0.003). The risk of cardiovascular events at 5 and 12 years was 5.5% and 14%, with a median latent time of 67 months (range: 23-179 months) from the end of radiotherapy. Pulmonary toxicity developed in 8% of patients; all had received mediastinal irradiation and the median time from radiotherapy to pulmonary sequelae was 76 weeks (range: 50-123 weeks). The risk of secondary neoplasia at 5 and 12 years was 4% and 8%, respectively, with no cases of leukemia. Fertility was preserved. Conclusions: Long-term events were mostly related to radiotherapy; the role of short ABVD chemotherapy was very limited, as documented by fertility preservation and lack of secondary myelodysplasia/leukemia. A proportion of patients died from causes unrelated to disease progression and the excess mortality risk was mostly due to the occurrence of secondary neoplasms and cardiovascular diseases. A moderate dose reduction of radiotherapy from 40-44 Gy to 30-36 Gy did not decrease the risk of late complications; abolishing radiotherapy in nonbulky early-stage Hodgkin's lymphoma is being evaluated.In early-stage Hodgkin's lymphoma, the combined modality therapy reduces the risk of relapse compared with radiotherapy alone and is considered, to date, the standard therapy, particularly in clinically staged patients and/or in those with unfavorable prognostic factors (1 -6). Attempts have been made in the last 15 years to possibly reduce the risk of therapyrelated long-term toxicity, particularly in the more favorable patient categories. Briefly, laparotomy was abolished, the doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) regimen, which had proved to be associated with a lower risk of gonadal damage (7) and secondary leukemia (8, 9), was adopted instead of regimens containing alkylating agents and procarbazine, and the dose and extension of radiotherapy were limited. Furthermore, because of the potential cardiac toxicity of doxorubicin and pulmonary toxicity of bleomycin (particularly when adjuvant mediastinal radiotherapy is given), the cumulative dose of both these drugs has been reduced by administering a limited number of ABVD courses (two to four). The results reported thu...

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Section: Discussionmentioning

confidence: 80%

Long-term Events in Adult Patients with Clinical Stage IA-IIA Nonbulky Hodgkin's Lymphoma Treated with Four Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine and Adjuvant Radiotherapy: A Single-Institution 15-Year Follow-up

Brusamolino¹,

Baio

Orlandi³

et al. 2006

Clinical Cancer Research

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“…Although extensive data are available on lung function in adult survivors of Hodgkin's lymphoma (HL)/ non-Hodgkin's lymphoma (NHL), 18,[65][66][67][68][69] there are few studies on pulmonary function after childhood HL/NHL. Bossi et al 26 reported that children with HL who received mediastinal irradiation of .…”

Section: Search Strategiesmentioning

confidence: 99%

Pulmonary Outcomes in Survivors of Childhood Cancer

Huang

Hudson

Stokes

et al. 2011

Chest

132

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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“…[29][30][31][32] Late toxicity of RT may include coronary alterations, myocardial and pericardial fibrosis, valvular abnormalities, conduction disturbances, and pulmonary fibrosis, with restrictive syndrome; the risk of toxicity is significantly enhanced by the combination of RT with CT containing doxorubicin and bleomycin. In the attempt to avoid RT-related toxicity, randomized studies have compared CT alone to combined modality therapy in patients with non-bulky early-stage Hodgkin's lymphoma.…”

Section: First-line Therapy For Early Stage Diseasementioning

confidence: 99%

“…In addition, RT (30)(31)(32)(33)(34)(35)(36) to residual nodal disease may be recommended in patients with a very good partial response after first-line chemotherapy with ABVD, Stanford V or BEACOPP regimens for advanced disease, and in patients with residual disease after salvage therapy with ASCT. In primary refractory disease, RT may have only a palliative role.…”

Section: The Role Of Radiotherapy For Limited Residual Diseasementioning

confidence: 99%