Late pulmonary sequelae after treatment of childhood cancer

Abstract

Objective – Increasingly successful treatment of childhood cancer during the last decades, resulting in a number of long term survivors, has made it possible to study late sequelae of this treatment in sizable cohorts of survivors. The aims were to determine the frequency and severity of pulmonary late sequelae among children treated for cancer to identify treatment risk factors and the methods for continued followup.

Materials and methods – In 255 of the 1020 survivors, at least 18 years old, 5 years after treatment, who agreed with the examination protocol, testing was performed at the time of their follow up appointment. It was conducted 5 to 37 (mean 18) years after diagnosis. The examinations included physical examination, chest radiograms and pulmonary function testing.

Results – Radiograms revealed 79 abnormalities in 53 patients and were most frequently found in patients with Hodgkin’s disease (20/67) or non-Hodgkin’s lymphoma treated with mediastinal radiotherapy (RT) (10/31), in patients with brain tumor treated with RT to the central nervous axis (CNA) (7/15), in Wilms’ tumor patients, who had abdominal RT, scoliosis was found. (6/15). Lung function tests showed abnormal values, mostly restrictive changes, in 59 of 237 patients.

Conclusion – Late pulmonary sequelae after treatment of childhood cancer are rare serious or life-threatening complications. Radiographic and pulmonary function abnormalities were most frequently found in patients who had mediastinal or CNA RT. Regular follow-up of these patients is therefore recommended. Spirometry has been a useful test for detection of pulmonary sequelae. Routinely follow-up radiography is always indicated in clinical suspicion of secondary tumors.