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Pulmonary function after whole lung irradiation in pediatric patients with solid malignancies
Megan S Motosue1, Liang Zhu, Kumar Srivastava
1Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Whole lung irradiation for pediatric cancers causes long-term pulmonary dysfunction that worsens over time, even in asymptomatic patients. Boost irradiation further impairs lung function, highlighting the need for ongoing monitoring and interventions.
Area of Science:
- Pediatric Oncology
- Pulmonary Medicine
- Radiation Oncology
Background:
- Whole lung irradiation is a treatment for pediatric solid tumors with pulmonary metastases.
- Long-term pulmonary consequences of this treatment are not well-documented.
Purpose of the Study:
- To evaluate the long-term pulmonary function changes in pediatric cancer survivors treated with whole lung irradiation.
- To identify factors associated with pulmonary dysfunction post-treatment.
Main Methods:
- Retrospective study of 48 pediatric cancer survivors.
- Analysis of 171 pulmonary function tests (PFTs) over time.
- Correlation of PFTs with clinical features and irradiation details.
Main Results:
- High prevalence of PFT abnormalities (FVC, FEV1, TLC, DLCOcorr) despite few symptomatic patients.
- Significant longitudinal decline in FVC, FEV1, and TLC over a median of 9.7 years.
- Focal pulmonary boost irradiation linked to worse PFTs (FEV1/FVC, FEF25-75, RV, RV/TLC).
Conclusions:
- Pulmonary dysfunction is common and progressive after whole lung irradiation in pediatric cancer survivors.
- Boost irradiation exacerbates pulmonary impairment.
- A significant proportion of adult survivors are smokers, a factor potentially influencing lung health.
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