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Late Effects of the Respiratory System

    Table 14. Pulmonary Late Effects

    Predisposing TherapyPulmonary EffectsHealth Screening/Interventions
    DLCO = diffusing capacity of the lung for carbon monoxide; GVHD = graft-versus-host disease.
    Busulfan; carmustine (BCNU)/lomustine (CCNU); bleomycin; radiation impacting lungs; surgery impacting pulmonary function (lobectomy, metastasectomy, wedge resection)Subclinical pulmonary dysfunction; interstitial pneumonitis; pulmonary fibrosis; restrictive lung disease; obstructive lung diseaseHistory: cough, shortness of breath, dyspnea on exertion, wheezing
    Pulmonary exam
    Pulmonary function tests (including DLCO and spirometry)
    Chest x-ray
    Counsel regarding tobacco avoidance/smoking cessation
    In patients with abnormal pulmonary function tests and/or chest x-ray, consider repeat evaluation prior to general anesthesia
    Pulmonary consultation for patients with symptomatic pulmonary dysfunction
    Influenza and pneumococcal vaccinations
    Hematopoietic cell transplantation with any history of chronic GVHDPulmonary toxicity (bronchiolitis obliterans, chronic bronchitis, bronchiectasis)History: cough, shortness of breath, dyspnea on exertion, wheezing
    Pulmonary exam
    Pulmonary function tests (including DLCO and spirometry)
    Chest x-ray
    Counsel regarding tobacco avoidance/smoking cessation
    In patients with abnormal pulmonary function tests and/or chest x-ray, consider repeat evaluation prior to general anesthesia
    Pulmonary consultation for patients with symptomatic pulmonary dysfunction
    Influenza and pneumococcal vaccinations

    Refer to the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers for respiratory late effects information including risk factors, evaluation, and health counseling.

    References:

    1. Huang TT, Hudson MM, Stokes DC, et al.: Pulmonary outcomes in survivors of childhood cancer: a systematic review. Chest 140 (4): 881-901, 2011.
    2. Motosue MS, Zhu L, Srivastava K, et al.: Pulmonary function after whole lung irradiation in pediatric patients with solid malignancies. Cancer 118 (5): 1450-6, 2012.
    3. McDonald S, Rubin P, Maasilta P: Response of normal lung to irradiation. Tolerance doses/tolerance volumes in pulmonary radiation syndromes. Front Radiat Ther Oncol 23: 255-76; discussion 299-301, 1989.
    4. McDonald S, Rubin P, Phillips TL, et al.: Injury to the lung from cancer therapy: clinical syndromes, measurable endpoints, and potential scoring systems. Int J Radiat Oncol Biol Phys 31 (5): 1187-203, 1995.
    5. Kreisman H, Wolkove N: Pulmonary toxicity of antineoplastic therapy. Semin Oncol 19 (5): 508-20, 1992.
    6. Bossi G, Cerveri I, Volpini E, et al.: Long-term pulmonary sequelae after treatment of childhood Hodgkin's disease. Ann Oncol 8 (Suppl 1): 19-24, 1997.
    7. Fryer CJ, Hutchinson RJ, Krailo M, et al.: Efficacy and toxicity of 12 courses of ABVD chemotherapy followed by low-dose regional radiation in advanced Hodgkin's disease in children: a report from the Children's Cancer Study Group. J Clin Oncol 8 (12): 1971-80, 1990.
    8. Hudson MM, Greenwald C, Thompson E, et al.: Efficacy and toxicity of multiagent chemotherapy and low-dose involved-field radiotherapy in children and adolescents with Hodgkin's disease. J Clin Oncol 11 (1): 100-8, 1993.
    9. Hunger SP, Link MP, Donaldson SS: ABVD/MOPP and low-dose involved-field radiotherapy in pediatric Hodgkin's disease: the Stanford experience. J Clin Oncol 12 (10): 2160-6, 1994.
    10. Marina NM, Greenwald CA, Fairclough DL, et al.: Serial pulmonary function studies in children treated for newly diagnosed Hodgkin's disease with mantle radiotherapy plus cycles of cyclophosphamide, vincristine, and procarbazine alternating with cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine. Cancer 75 (7): 1706-11, 1995.
    11. Polliack A: Late therapy-induced cardiac and pulmonary complications in cured patients with Hodgkin's disease treated with conventional combination chemo-radiotherapy. Leuk Lymphoma 15 (Suppl 1): 7-10, 1995.
    12. Cerveri I, Fulgoni P, Giorgiani G, et al.: Lung function abnormalities after bone marrow transplantation in children: has the trend recently changed? Chest 120 (6): 1900-6, 2001.
    13. Kaplan EB, Wodell RA, Wilmott RW, et al.: Late effects of bone marrow transplantation on pulmonary function in children. Bone Marrow Transplant 14 (4): 613-21, 1994.
    14. Leiper AD: Non-endocrine late complications of bone marrow transplantation in childhood: part II. Br J Haematol 118 (1): 23-43, 2002.
    15. Marras TK, Chan CK, Lipton JH, et al.: Long-term pulmonary function abnormalities and survival after allogeneic marrow transplantation. Bone Marrow Transplant 33 (5): 509-17, 2004.
    16. Nenadov Beck M, Meresse V, Hartmann O, et al.: Long-term pulmonary sequelae after autologous bone marrow transplantation in children without total body irradiation. Bone Marrow Transplant 16 (6): 771-5, 1995.
    17. Nysom K, Holm K, Hesse B, et al.: Lung function after allogeneic bone marrow transplantation for leukaemia or lymphoma. Arch Dis Child 74 (5): 432-6, 1996.
    18. Inaba H, Yang J, Pan J, et al.: Pulmonary dysfunction in survivors of childhood hematologic malignancies after allogeneic hematopoietic stem cell transplantation. Cancer 116 (8): 2020-30, 2010.
    19. Frisk P, Arvidson J, Hedenström H: A longitudinal study of pulmonary function after stem cell transplantation, from childhood to young adulthood. Pediatr Blood Cancer 58 (5): 775-9, 2012.
    20. Schultz KR, Green GJ, Wensley D, et al.: Obstructive lung disease in children after allogeneic bone marrow transplantation. Blood 84 (9): 3212-20, 1994.
    21. Uderzo C, Pillon M, Corti P, et al.: Impact of cumulative anthracycline dose, preparative regimen and chronic graft-versus-host disease on pulmonary and cardiac function in children 5 years after allogeneic hematopoietic stem cell transplantation: a prospective evaluation on behalf of the EBMT Pediatric Diseases and Late Effects Working Parties. Bone Marrow Transplant 39 (11): 667-75, 2007.
    22. Yoshihara S, Yanik G, Cooke KR, et al.: Bronchiolitis obliterans syndrome (BOS), bronchiolitis obliterans organizing pneumonia (BOOP), and other late-onset noninfectious pulmonary complications following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 13 (7): 749-59, 2007.
    23. Kreisel D, Krupnick AS, Huddleston CB: Outcomes and late complications after pulmonary resections in the pediatric population. Semin Thorac Cardiovasc Surg 16 (3): 215-9, 2004.
    24. Mertens AC, Yasui Y, Liu Y, et al.: Pulmonary complications in survivors of childhood and adolescent cancer. A report from the Childhood Cancer Survivor Study. Cancer 95 (11): 2431-41, 2002.

    WebMD Public Information from the National Cancer Institute

    Last Updated: February 25, 2014
    This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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