Pulmonary Function after Treatment for Childhood Cancer. A Report from the St. Jude Lifetime Cohort Study (SJLIFE)

Background Children with high-risk neuroblastoma (NB) are exposed to multimodality therapies early in life and survivors confront late therapy-related toxicities. This study assessed respiratory symptoms, pulmonary function tests (PFTs), and risk factors for abnormalities among survivors. Methods High-risk NB survivors followed in the Long-term Follow-up clinic at Memorial Sloan Kettering Cancer Center were enrolled. Self-administered symptom questionnaires were completed. Medical records were reviewed for treatment information and co-morbidities. PFTs included spirometry, plethysmography, and diffusion capacity of the lung for carbon monoxide (DLCO). Results Thirty nine survivors participated (median age at study: 11.4 years; median age at diagnosis: 2.3 years; median time since completion of therapy: 5.5 years). Chronic respiratory symptoms were reported for 33%. PFT abnormalities were identified in 79% and included low forced expiratory volume in 1 second (FEV1) (38%), decreased total lung capacity (TLC) (44%), and abnormal DLCO (67%). PFT abnormalities were mostly mild to moderate. Mean forced vital capacity, forced expiratory volume in 1 second, and total lung capacity were normal and mean DLCO was mildly abnormal. Risks included thoracic surgery, chest radiation therapy (RT), thoracic surgery plus chest RT, and shorter time since completion of therapy (p<0.05). Conclusions While respiratory abnormalities were common, they were mostly mild or moderate. Continued pulmonary surveillance of this at-risk population is warranted.

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“…31, 32 Interestingly, in this cohort, PFT impairments were mostly mild to moderate in severity. The most common abnormality was decreased DLCO.…”

Section: Discussionmentioning

confidence: 67%

Long-term Pulmonary Outcomes in Pediatric Survivors of High-risk Neuroblastoma

Stone

Friedman

Worgall

et al. 2017

Journal of Pediatric Hematology/Oncology

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“…One third of these patients did have abnormal pulmonary function which is likely to have biased our results toward the null. We have previously demonstrated an association between pulmonary function and performance on the six minute walk test in the overall SJLIFE cohort [7]. …”

Section: Discussionmentioning

confidence: 99%

“…Among childhood sarcoma survivors, this condition may contribute to an already compromised respiratory system as certain anticancer therapies in childhood are associated with long-term pulmonary toxicity [7, 8]. Furthermore, children treated for sarcoma are at risk for bone mineral density deficits, which may predispose them to spinal deformity [9].…”

Section: Introductionmentioning

confidence: 99%

Associations between treatment, scoliosis, pulmonary function, and physical performance in long-term survivors of sarcoma

Interiano

Kaste

et al. 2017

J Cancer Surviv

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Purpose Longer survival for children with sarcoma has led to the recognition of chronic health conditions related to prior therapy. We sought to study the association of sarcoma therapy with the development of scoliosis. Methods We reviewed patient demographics, treatment exposures, and functional outcomes for patients surviving > 10 years after treatment for sarcoma between 1964–2002 at our institution. The diagnosis of scoliosis was determined by imaging. Functional performance and standardized questionnaires were completed in a long-term follow-up clinic. Results We identified 367 patients, with median age at follow-up of 33.1 years. Scoliosis was identified in 100 (27.2%) patients. Chest radiation [relative risk (RR): 1.88 (95% confidence interval [CI]: 1.21–2.92, p < 0.005,)] and rib resection [RR: 2.64 (CI: 1.79–3.89), p < 0.0001] were associated with an increased incidence of scoliosis; thoracotomy without rib resection was not. Of 21 patients who underwent rib resection, 16 (80.8%) had the apex of scoliosis towards the surgical side. Scoliosis was associated with worse pulmonary function [RR: 1.74 (CI: 1.14–2.66, p < 0.01] and self-reported health outcomes, including functional impairment [RR: 1.60 (CI: 1.07–2.38), p < 0.05] and cancer-related pain [RR: 1.55 (CI: 1.11–2.16), p < 0.01]. Interestingly, pulmonary function was not associated with performance on the six minute walk test in this young population. Conclusions Children with sarcoma are at-risk of developing scoliosis when treatment regimens include chest radiation or rib resection. Identification of these risk factors may allow for early intervention designed to prevent adverse long-term outcomes. Implications for Cancer Survivors Cancer survivors at risk of developing scoliosis may benefit from monitoring of pulmonary status and early physical therapy.

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“…left in place after the patient is discharged, and then checked and removed when possible in an outpatient setting. After pulmonary metastasectomy for cancer, Pulmonary function can be impaired in patients in treatment and also in adult survivors (28,29), who often present restrictive syndrome and decreased physical function.…”

Section: Discussionmentioning

confidence: 99%

Metastasectomy in pediatric patients: indications, technical tips and outcomes

Scanagatta

Girelli

2017

J. Thorac. Dis.

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Pulmonary metastasectomy has become a standard procedure for pediatric patients with certain types of solid tumors. Surgeons, expert pediatric oncologists and radiation oncologists contribute with their different skills to the management of pulmonary metastases. Patients are usually scheduled for surgery in case of primary tumor control, in absence of metastases in other organs and when a complete resection is achievable. Nodules are removed through precision resections using electrocautery or laser methods in order to ensure radical surgery with adequate margins. With these techniques, it is possible to preserve the surrounding parenchyma and cause a limited volumetric distortion as compared with staplers. Anatomical resections (segmentectomy, lobectomy or pneumonectomy) should be reserved for selected cases, since major lung resection can only be justified if it leads to a real oncological advantage. Repeated thoracotomies are possible, since there is no theoretical limit to reinterventions. Surgery of lung metastases has a therapeutic and curative role for some histology with acceptable rate of complications but it finds its role only in an aggressive multimodality approach. Indications can be discussed case by case and exceptions can be evaluated also in presence of different evidences. Children affected by metastatic tumors need to be managed by expert multidisciplinary oncological team in referral center with large experience.

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Pulmonary Function after Treatment for Childhood Cancer. A Report from the St. Jude Lifetime Cohort Study (SJLIFE)

Cited by 30 publications

References 42 publications

Long-term Pulmonary Outcomes in Pediatric Survivors of High-risk Neuroblastoma

Long-term Pulmonary Outcomes in Pediatric Survivors of High-risk Neuroblastoma

Associations between treatment, scoliosis, pulmonary function, and physical performance in long-term survivors of sarcoma

Metastasectomy in pediatric patients: indications, technical tips and outcomes

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