Pulmonary Fibrosis and Pulmonary Function in Patients with Metastatic Testicular Cancer During and after Combination
Lisa Frey1, Salma Grunwald1, Christian Ruckes2
1Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany.
Background And Objective:
Metastatic testicular germ cell tumors (mTGCTs) are treated with combination chemotherapy (Cx) containing bleomycin (BEP [bleomycin, etoposide, and cisplatin]). Bleomycin-induced pulmonary toxicity (BPT) is a serious Cx-associated complication. This study aimed to investigate the association between radiographic changes in computed tomography of the chest (CT-T) and pulmonary function tests (PFTs) during, shortly after, and long term after BEP.
Methods:
In this nonrandomized, monocentric cohort study, we included patients with mTGCT who were treated with a minimum of two cycles of BEP. Pulmonary changes associated with BPT were extracted from CT-T scans performed before the first (baseline CT-1), after the second cycle (CT-2), and after the last cycle (CT-3) of BEP. Corresponding PFTs were performed before each new cycle. A current PFT was used to evaluate long-term toxicity. Statistical analyses were carried out using the McNemar test, the Fisher exact test, the Wilcoxon signed-rank test, and multivariable regression analyses.
Key Findings And Limitations:
We identified 85 patients (38 had seminomas, and 47 had nonseminomas). Thirty-two patients received a current PFT. After two cycles of BEP, 21% of the patients showed radiographic BPT and 20% PFT deterioration. The association between CT and PFT changes was significant (odds ratio [OR] = 10.65 [95% confidence interval {CI} = 3.1-37.6]; p < 0.001). During BEP, the proportion of patients with deterioration in PFTs increased from 7.1% to 22% (Δ = 0.176 [95% CI = 0.076 - 0.277]; p = 0.0046). All patients with current PFT deterioration showed BPT after the second BEP cycle (CT-2); however, the association was not significant (OR = 6.25 [95% CI = 0.68-57.9]; p = 0.14).
Conclusions And Clinical Implications:
BPT is a common radiographic finding during and after BEP. Radiographic changes in CT-2 were significantly associated with reduced PFT. However, in most patients, PFT recovered over time with no radiographic correlation to any time point of CT-T during BEP. Therefore, routine CT-T during ongoing BEP should not be performed for BPT detection and should only be considered in patients who are clinically symptomatic.
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