Late Effects of Treatment for Childhood Cancer

Table 10. Pulmonary Late Effects^a

Late Effects Causative treatment Signs and Symptoms Screening and Diagnostic Tests Management and Intervention

^aAdapted from Schwartz et al.[37]

Pulmonary fibrosis Chemotherapy: Bleomycin (Blenoxane), lomustine (CCNU), carmustine (BCNU), cyclophosphamide, methotrexate, mitomycin, vinca alkaloids Fatigue, cough, dyspnea on exertion, reduced exercise tolerance, orthopnea, cyanosis, finger clubbing, rales, cor pulmonale Baseline chest x-ray and O₂ saturation, pulmonary function test including diffusing capacity for carbon monoxide, then every 3–5 years or as needed Consider pulmonary evaluation, steroid therapy; prevention: avoidance of smoking. Avoidance of infections: influenza vaccine, Pneumovax after bleomycin: avoid fractional inspired oxygen (FiO₂) >30% intraoperatively and postoperatively avoid excessive hydration

Radiation: Pulmonary radiation therapy >15–20 Gy, risk increases with dose, larger volume irradiated, and younger age

References

Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.