BACKGROUND. Carmustine (BCNU) is an anticancer drug known to produce pulmonary fibrosis as a side effect within three years of treatment. It is not known whether pulmonary fibrosis can appear later. METHODS. To investigate the clinical range of this side effect, we studied the survivors among 31 children treated with carmustine for brain tumors between 1972 and 1976. Fourteen had died of their tumor; of the remaining 17, 6 had died of lung fibrosis--2 within 3 years of treatment and 4 from 8 to 13 years after treatment. This report focuses primarily on the 11 survivors, 8 of whom were available for detailed study 13 to 17 years (mean, 14) after treatment. RESULTS. Of the eight survivors studied, six had abnormal chest radiographs showing predominantly upper-zone fibrotic changes. These patients also had abnormal CT scans, showing a previously undescribed pattern of upper-zone fibrosis. All the survivors studied had restrictive spirometric defects (mean [+/- SD] vital capacity, 54 +/- 19 percent of the predicted value). Bronchoalveolar-lavage fluid contained abnormal proportions of specific macrophage subgroups. Light and electron microscopy in six patients revealed interstitial fibrosis and elastosis with damage to epithelial and endothelial cells. Four patients had symptoms (shortness of breath, cough, or both). CONCLUSIONS. Carmustine chemotherapy in childhood causes lung fibrosis that may remain asymptomatic for many years or become symptomatic at any time.
Source Information
Northwest Regional Cardiothoracic Unit, Wythenshawe Hospital, Manchester, United Kingdom.
This article has been cited by other articles:
Tyc, V. L., Lensing, S., Vukadinovich, C. M., Hovell, M. F.
(2009). Can parents of children with cancer accurately report their child's passive smoking exposure?. Nicotine Tob Res
11: 1289-1295
[Abstract][Full Text]
Kamp, D. W.
(2009). Drug-Induced Lung Diseases. ACCP Pulmonary Med Brd Rev
25: 319-344
[Full Text]
LILES, A., BLATT, J., MORRIS, D., WARDROP, R. III, SHARMA, A., SZNEWAJS, A., GOLDSBY, R.
(2008). Monitoring pulmonary complications in long-term childhood cancer survivors: Guidelines for the primary care physician. Cleveland Clinic Journal of Medicine
75: 531-539
[Abstract][Full Text]
Tyc, V. L.
(2007). Strategies for Tobacco Control Among Youngsters with Cancer. J Pediatr Psychol
32: 1067-1078
[Abstract][Full Text]
Tyc, V. L., Throckmorton-Belzer, L.
(2006). Smoking Rates and the State of Smoking Interventions for Children and Adolescents With Chronic Illness. Pediatrics
118: e471-e487
[Abstract][Full Text]
Hall, D. E., Moffat, B. A., Stojanovska, J., Johnson, T. D., Li, Z., Hamstra, D. A., Rehemtulla, A., Chenevert, T. L., Carter, J., Pietronigro, D., Ross, B. D.
(2004). Therapeutic Efficacy of DTI-015 using Diffusion Magnetic Resonance Imaging as an Early Surrogate Marker. Clin. Cancer Res.
10: 7852-7859
[Abstract][Full Text]
Lohani, S., O'Driscoll, B. R., Woodcock, A. A.
(2004). 25-Year Study of Lung Fibrosis Following Carmustine Therapy for Brain Tumor in Childhood. Chest
126: 1007-1007
[Full Text]
Oeffinger, K. C., Hudson, M. M.
(2004). Long-term Complications Following Childhood and Adolescent Cancer: Foundations for Providing Risk-based Health Care for Survivors. CA Cancer J Clin
54: 208-236
[Abstract][Full Text]
Parish, J. M., Muhm, J. R., Leslie, K. O.
(2003). Upper Lobe Pulmonary Fibrosis Associated With High-Dose Chemotherapy Containing BCNU for Bone Marrow Transplantation. Mayo Clin Proc.
78: 630-634
[Abstract]
Tyc, V. L., Rai, S. N., Lensing, S., Klosky, J. L., Stewart, D. B., Gattuso, J.
(2003). Intervention to Reduce Intentions to Use Tobacco Among Pediatric Cancer Survivors. JCO
21: 1366-1372
[Abstract][Full Text]
Mertens, A. C., Yasui, Y., Neglia, J. P., Potter, J. D., Nesbit, M. E. Jr, Ruccione, K., Anthony Smithson, W., Robison, L. L.
(2001). Late Mortality Experience in Five-Year Survivors of Childhood and Adolescent Cancer: The Childhood Cancer Survivor Study. JCO
19: 3163-3172
[Abstract][Full Text]
Briasoulis, E., Pavlidis, N.
(2001). Noncardiogenic Pulmonary Edema: An Unusual and Serious Complication of Anticancer Therapy. The Oncologist
6: 153-161
[Abstract][Full Text]
Schwartz, C. L.
(1999). Long-Term Survivors of Childhood Cancer: The Late Effects of Therapy. The Oncologist
4: 45-54
[Abstract][Full Text]
Robertson, C M, Hawkins, M M, Kingston, J E
(1994). Late deaths and survival after childhood cancer: implications for cure. BMJ
309: 162-167
[Abstract][Full Text]
Durivage, H. J., Burnham, N. L.
(1991). Prevention and Management of Toxicities Associated With Antineoplastic Drugs. Journal of Pharmacy Practice
4: 27-48
Davis, L. E.
(1991). Long-Term Complications of Antineoplastic Agents. Journal of Pharmacy Practice
4: 131-150
Previous
