Pulmonary

Pulmonary complications in cancer survivors can be related to chemotherapy and radiation therapy. Chemotherapy agents most commonly associated with late pulmonary toxicity include bleomycin, nitrosoureas, cyclophosphamide, melphalan, and busulfan (Mäkipernaa et al. 1989;Nenadov Beck et al. 1995; Neve et al. 1999). A recent study from the Childhood Cancer Survivor Study (CCSS) showed that cisplatin was associated with an increased risk of lung fibrosis in pediatric cancer survivors (Mertens et al. 2002).

In the same study, chest irradiation was associated with a 3.5% cumulative incidence of lung fibrosis at 20 years after diagnosis (Mertens et al. 2002). Three studies reported on the long-term pulmonary sequelae in neuroblastoma patients (Mäkipernaa et al. 1989; Nenadov Beck et al. 1995; Neve et al. 1999). The most common pulmonary function test (PFT) abnormality reported was restrictive ventilatory defect with decreased lung volumes (Mäkipernaa et al. 1989; Nenadov Beck et al. 1995; Neve et al. 1999). More PFT defects were observed in patients younger than 3 years at diagnosis and those with spinal deformities. TBI was not associated with a significant deterioration in pulmonary function, except in patients treated at a very young age (Neve et al. 1999).

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