BACKGROUND: Although whole lung irradiation is used to treat pulmonary metastases of pediatric solid malignancies, few studies have addressed its long-term pulmonary consequences. METHODS: The authors conducted a retrospective study of longitudinal changes in 171 pulmonary function tests (PFTs) and their relation with clinical features in 48 survivors of pediatric malignant solid tumors treated with whole lung irradiation. RESULTS: Although active respiratory symptoms were seen in only 9 patients (18.8%), abnormalities in forced vital capacity (FVC; 58.3%), forced expiratory volume in 1 second (FEV1; 64.6%), total lung capacity (TLC; 72.9%), and diffusion capacity of the lung for carbon monoxide corrected for hemoglobin (DLCOcorr; 70.8%) were common. At a median follow-up of 9.7 years after whole lung irradiation, FVC, FEV1, and TLC significantly declined longitudinally (P = .04, .03, and .02, respectively). Focal pulmonary boost irradiation was significantly associated with abnormal FEV1/FVC (P = .03), forced expiratory flow between 25% and 75% forced vital capacity (P = .005), residual volume (RV; P = .005), and RV/TLC (P = .002). Ten patients had baseline PFTs, and FVC, FEV1, TLC, and DLCOcorr worsened immediately after radiation, followed by transient improvement but subsequent decline. Thirteen of 32 (40.6%) patients aged >18 years were smokers. CONCLUSIONS: Pulmonary dysfunction was prevalent after whole lung irradiation and worsened over time, although most patients were asymptomatic. Boost irradiation impaired pulmonary function, and a significant proportion of patients were smokers. Further studies are planned to assess the predictors and clinical consequences of progressive PFT abnormalities and to evaluate educational interventions. Cancer 2012; 118: 1450-6. (C) 2011 American Cancer Society.
机构:
Univ Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USAUniv Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USA
Abid, SH
Malhotra, V
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Univ Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USAUniv Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USA
Malhotra, V
Perry, MC
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Univ Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USAUniv Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USA
机构:
Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10032 USAColumbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10032 USA
Goodwin, Renee D.
Cowles, Robert A.
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Columbia Univ, Coll Phys & Surg, Dept Surg, Div Pediat Surg, New York, NY 10032 USAColumbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10032 USA
机构:
Univ Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USAUniv Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USA
Abid, SH
Malhotra, V
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Univ Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USAUniv Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USA
Malhotra, V
Perry, MC
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Univ Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USAUniv Missouri, Ellis Fischel Canc Ctr, Div Hematol Med Oncol, W Columbia, MO 65203 USA
机构:
Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10032 USAColumbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10032 USA
Goodwin, Renee D.
Cowles, Robert A.
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Columbia Univ, Coll Phys & Surg, Dept Surg, Div Pediat Surg, New York, NY 10032 USAColumbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10032 USA