Pulmonary Outcomes in Survivors of Childhood Cancer

Abstract

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

Yield of Screening for Long-Term Complications Using the Children's Oncology Group Long-Term Follow-Up Guidelines

“…In particular, for the 84% of survivors who received potentially pulmonary toxic therapy and were identified with previouslyunrecognizedsubclinicalpulmonarydysfunctiononscreening evaluation, the implications of these findings are as yet unknown. However, because pulmonary function declines with age, these findings may portend future symptomatic pulmonary dysfunction as this population ages 50 and thus may have implications for the need to develop interventions to preserve or enhance pulmonary function in this vulnerable population. Pre-existing conditions, screening yield, and overall prevalence for (A) high-yield (Ն 10%), (B) intermediate-yield (Ն 1% to Ͻ 10%), and (C) negligible/ negative-yield (Ͻ 1%) screening tests.…”

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…49 Bleomycin-induced pulmonary toxicity is well documented in patients with HL treated with bleomycin-containing chemotherapy regimens. 58 Higher cumulative doses of cisplatin, ifosfamide, or epipodophyllotoxins are associated with hearing loss, renal dysfunction, and secondary AML, respectively. [59][60][61][62] See also the section on "Late Effects in AYA Cancer Survivors" in the complete version of these guidelines (available at NCCN.org).…”

Unsuspected Lung Pathology in Autopsies of Children with Cancer

“…acute or chronic pulmonary complications in patients with current or past cancer are well characterized in the medical literature, both in children and adults 12,[22][23][24][25][26] . these complications are diverse and include infections, fibrosis, diffuse alveolar hemorrhage; tumor infiltration, metastases, atelectasis and vascular or hemorrhagic conditions such as vascular leakage with edema and infarction, hemorrhage, pulmonary thromboembolism, etc.…”