Pulmonary epithelial permeability in patients treated with bleomycin containing chemotherapy detected by technetium-99m diethylene triamine penta-acetic acid aerosol (99mTc-DTPA) scintigraphy

Purpose: To evaluate pulmonary epithelial permeability using Tc-99m-DTPA scintigraphy in patients treated with bleomycin-containing regimens. Material and Methods: Twelve nonsmoking chemotherapy-naive patients with no clinical or radiological evidence of pulmonary disease and treated with bleomycin-containing chemotherapy were tested with Tc-99m-DTPA scintigraphy before the first cycle and every 3 weeks until the third month after the end of chemotherapy (total cumulative dose of bleomycin 347.9 mg). Results: Pretreatment values (T-1/2 74.93 minutes) of Tc-99m-DTPA scintigraphy were significantly higher than those obtained after the total dose of bleomycin (T-1/2 51.00 minutes) (p < 0.001). This difference was more important in the later evaluations especially, on the third week and third month measures after discontinuing treatment (p < 0.001). All the tests of Within-Subjects Effects were significant (p < 0.001). Comparing pretreatment and post-treatment scintigraphies the mean T-1/2 Tc-99m-DTPA values decreased as the bleomycin dose increased. Conclusion: We conclude that cumulative bleomycin doses are related to increased pulmonary epithelial permeability at a dose of 256.5 mg. However, whether this is related to clinical toxicity is uncertain and large, multi-center prospective studies are needed.