Childhood cancer survivors can be at risk for developing the following pulmonary late effects:
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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:
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Time since treatment
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Age at treatment
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Total dose of radiation
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Total dose of chemotherapy
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Smoking
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High dose oxygen support such as during general anesthesia
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Chemotherapy
Table 1
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Pulmonary Fibrosis
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Interstitial Pneumonitis
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Acute Respiratory Distress Syndrome
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Restrictive Lung Disease
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Obstructive Lung Disease
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Alkylating Agents
Carmustine
BCNU
Busulfan
Lomustine
CCNU
Chlorambucil Cyclophosphamide
Cytoxan
Ifosphamide
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
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X
(Busulfan,
BCNU &
CCNU only)
|
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X
(Bleomycin Only)
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bronchiectasis)
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Heavy Metals
Carboplatin
Cisplatin
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Mini-mantle only
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Mini-mantle only
|
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Mini-mantle only
|
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
|
|
|
|
|
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
Epipodophyllotoxins
|
X
(Bleomycin Only)
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|
|
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Chemotherapy
Table 2
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Pulmonary Fibrosis
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Interstitial Pneumonitis
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Acute Respiratory Distress Syndrome
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Restrictive Lung Disease
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Obstructive Lung Disease
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Anti-tumor
antibiotics
Bleomycin
Dactinomycin
|
X
(Bleomycin Only)
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X
(Bleomycin Only)
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X
(Bleomycin Only)
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bronchiectasis)
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Corticosteroids
Dexamethasone
Decadron
Prednisone
|
Mini-mantle only
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Mini-mantle only
|
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Mini-mantle only
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Enzymes
Asparaginase
|
|
|
|
|
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Plant alkaloids
Vincristine
Vinblastine
|
|
|
|
|
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
|
|
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Radiation
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Pulmonary Fibrosis
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Interstitial Pneumonitis
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Acute Respiratory Distress Syndrome
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Restrictive Lung Disease
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Obstructive Lung Disease
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All Radiation
|
|
|
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bronchiectasis)
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TBI
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X
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X
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X
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X
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Head/Brain
|
|
|
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Neck
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Mini-mantle only
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Mini-mantle only
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(Bleomycin Only)
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Mini-mantle only
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Mini-mantle only
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Thorax
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X
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X
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X
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X
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Abdomen
|
|
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Pelvis
|
|
|
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Extremity
Epipodophyllotoxins
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X
(Bleomycin Only)
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Hematopoeitic Stem Cell Transplant
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Pulmonary Fibrosis
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Interstitial Pneumonitis
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Acute Respiratory Distress Syndrome
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Restrictive Lung Disease
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Obstructive Lung Disease
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Hematopoeitic Stem Cell
Transplant with any history of chronic GVHD
Epipodophyllotoxins
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X
(Bleomycin Only)
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Mini-mantle only
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(Bleomycin Only)
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Mini-mantle only
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X
(Bronchiolitis
obliterans,
chronic
bronchitis &
bronchiectasis)
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Surgery
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Pulmonary Fibrosis
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Interstitial Pneumonitis
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Acute Respiratory Distress Syndrome
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Restrictive Lung Disease
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Obstructive Lung Disease
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Pulmonary Lobectomy
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Mini-mantle only
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Mini-mantle only
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(Bleomycin Only)
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X
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bronchiectasis)
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Pulmonary Metastasectomy
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|
|
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X
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Pulmonary Wedge Resection
Epipodophyllotoxins
|
X
(Bleomycin Only)
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X
Mini-mantle only
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