Increased Risk of Long-Term Pulmonary Dysfunction in Survivors of Childhood Cancer Who Received Pulmonary Toxic Treatments
In a single-center study reported in the Journal of Clinical Oncology, Armenian et al found that childhood cancer survivors who had received potentially pulmonary toxic treatment were at a significantly increased risk of long-term pulmonary dysfunction compared with healthy controls.
Study Details
The study involved 121 patients from the Childhood Cancer Survivorship Clinic at City of Hope who underwent pulmonary function testing at baseline and follow-up. Criteria for pulmonary function screening were previous exposure to pulmonary toxic chemotherapy (bleomycin, busulfan, nitrosoureas), chest radiation, history of allogeneic hematopoietic cell transplantation with chronic graft-vs-host disease, or pulmonary surgery (lobectomy, metastectomy, wedge resection). Survivors underwent follow-up pulmonary function evaluation at a median of 5 years (range = 1.0–10.3 years), and outcomes at this evaluation were compared with testing in 43 age- and sex-matched healthy controls. The median age at cancer diagnosis was 16.5 years (range = 0.2–21.9 years), and the median time from diagnosis to follow-up testing was 17.1 years (range = 6.3–40.1 years).
Worse Function
Compared with healthy controls, patients had a 6.5-fold greater risk of restrictive defects (odds ratio [OR] = 6.5, P < .01) and a 5.2-fold greater risk of diffusion abnormalities (OR = 5.2, P < .01). Age < 16 years at diagnosis (OR = 3.0, P = .02) and exposure to > 20 Gy chest radiation (OR = 5.6, P = .02, vs no chest radiation) were significantly associated with restrictive defects. Female sex (OR = 3.9, P < .01) and chest radiation dose (OR = 6.4, P < .01, for ≤ 20 Gy and OR = 11.3, P < .01, for > 20 Gy vs no radiation) were significantly associated with diffusion abnormalities. Among patients with normal pulmonary function at baseline, female patients and patients receiving > 20 Gy chest radiation exhibited worsening diffusion function over time.
The investigators concluded: “Childhood cancer survivors exposed to pulmonary-toxic therapy are significantly more likely to have restrictive and diffusion defects when compared with healthy controls. Diffusion capacity declines with time after exposure to pulmonary-toxic therapy, particularly among females and survivors treated with high-dose chest radiation. These individuals could benefit from subsequent monitoring.”
Saro Armenian, DO, of City of Hope National Medical Center, is the corresponding author of the Journal of Clinical Oncology article.
The study was supported by the National Cancer Institute and STOP Cancer Foundation. Wendy Landier, PhD, RN, NP, reported institutional research funding from Merck, Sharp & Dohme.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
