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Pulmonary QuickFact

Childhood cancer survivors can be at risk for developing the following pulmonary late effects:

  • Pulmonary Fibrosis
  • Interstitial Pneumonitis
  • Acute Respiratory Distress Syndrome
  • Restrictive Lung Disease
  • Obstructive Lung Disease

 

If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic. 

 

Important factors in determining risk for pulmonary late effects:

   

    • Time since treatment
    • Age at treatment
    • Total dose of radiation
    • Total dose of chemotherapy
    • Smoking
    • High dose oxygen support such as during general anesthesia

 

 

 

 

Chemotherapy

Table 1

 

Pulmonary Fibrosis

Interstitial Pneumonitis

Acute Respiratory Distress Syndrome

Restrictive Lung Disease

Obstructive Lung Disease

Alkylating Agents

Carmustine

   BCNU

Busulfan

Lomustine

   CCNU

Chlorambucil Cyclophosphamide

   Cytoxan

Ifosphamide

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

X

(Busulfan,

BCNU &

CCNU only)

 

X

(Bleomycin Only)

 

bronchiectasis)

Heavy Metals

Carboplatin

Cisplatin

 

Mini-mantle only

Mini-mantle only

 

Mini-mantle only

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

 

 

 

 

 

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

Epipodophyllotoxins

X

(Bleomycin Only)

 

 

 

 

Chemotherapy

Table 2                                   

 

Pulmonary Fibrosis

Interstitial Pneumonitis

Acute Respiratory Distress Syndrome

Restrictive Lung Disease

Obstructive Lung Disease

Anti-tumor

antibiotics

Bleomycin

Dactinomycin

 

X

(Bleomycin Only)

X

(Bleomycin Only)

X

(Bleomycin Only)

 

bronchiectasis)

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

Mini-mantle only

Mini-mantle only

 

Mini-mantle only

 

Enzymes

Asparaginase

 

 

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

 

 

 

 

Radiation                           

 

 

Pulmonary Fibrosis

Interstitial Pneumonitis

Acute Respiratory Distress Syndrome

Restrictive Lung Disease

Obstructive Lung Disease

All Radiation

 

 

 

 

bronchiectasis)

TBI

X

X

 

X

X

Head/Brain

 

 

 

 

 

Neck

Mini-mantle only

Mini-mantle only

(Bleomycin Only)

Mini-mantle only

Mini-mantle only

Thorax

X

X

 

X

X

Abdomen

 

 

 

 

 

Pelvis

 

 

 

 

 

Extremity

Epipodophyllotoxins

X

(Bleomycin Only)

 

 

 

 

Hematopoeitic Stem Cell Transplant

 

Pulmonary Fibrosis

Interstitial Pneumonitis

Acute Respiratory Distress Syndrome

Restrictive Lung Disease

Obstructive Lung Disease

Hematopoeitic Stem Cell  Transplant with any history of chronic GVHD

Epipodophyllotoxins

X

(Bleomycin Only)

Mini-mantle only

(Bleomycin Only)

Mini-mantle only

X

(Bronchiolitis

obliterans,

chronic

bronchitis &

bronchiectasis)

Surgery

 

 

Pulmonary Fibrosis

Interstitial Pneumonitis

Acute Respiratory Distress Syndrome

Restrictive Lung Disease

Obstructive Lung Disease

Pulmonary Lobectomy                 

Mini-mantle only

Mini-mantle only

(Bleomycin Only)

X

bronchiectasis)

Pulmonary Metastasectomy

 

 

 

X

 

Pulmonary Wedge Resection

Epipodophyllotoxins

X

(Bleomycin Only)

 

 

X

 Mini-mantle only

 

 

For recommendations on how to screen for all potential late effects please refer to The Children's Oncology Group Long-term Follow-up Guidelines.

Health Links-Teaching Handouts from The Children's Oncology Group       

Visit http://www.survivorshipguidelines.org/ to find many of the Health Links translated into other languages.

Reference:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 2/10/2015 8:01:44 PM
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