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