Andrea S Hinkle Cindy Proukou Yuhchyau Chen

Chemo Secrets From a Breast Cancer Survivor

Breast Cancer Survivors

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Contents

11.1 Pathophysiology 161

11.1.1 Development of the Lung 161

11.1.2 Pathophysiologic Changes Induced by Cytotoxic Therapy 162

11.2 Clinical Manifestations 165

11.2.1 Long-Term Effect in Pediatric Population 165

11.2.2 Radiotherapy:Clinical Presentations . . . 166

11.2.2.1 Subacute Radiation Pneumonitis. 166

11.2.2.2 Radiation Fibrosis 166

11.2.2.3 Radiation Tolerance Doses and Tolerance Volumes 167

11.2.3 Chemotherapy:Clinical Manifestations. . 168

11.2.4 Chemotherapy-

Chemotherapy Interactions 171

11.2.5 Radiation and Chemotherapy Combinations: Interaction and Tolerance 171

11.3 Detection and Screening 171

11.3.1 Measurable Endpoints 172

11.4 Management of Established Pulmonary

Toxicity Induced by Cytotoxic Therapy 174

11.4.1 Precautions for Minimizing Potential Complications . 174

11.4.2 Preventative Therapy 175

11.4.3 Therapy for Established Toxicity 175

11.5 Future Studies 175

References 176

Long-term follow up of children and adolescents treated with chemotherapy and/or radiation has demonstrated the potential for significant impact on pulmonary function and thoracic development. Both radiation therapy (RT) and chemotherapy can acutely and chronically affect lung function. Thoracic irradiation in children can cause developmental abnormalities including inhibited growth of the thoracic cage resulting in impairment of pulmonary function. Other effects of direct radiation on the lungs include pneumonitis and fibrosis. Pulmonary effects of cyto-toxic drugs usually present as acute effects and less frequently as long-term effects, but there is the potential for significant late morbidity and mortality. Although treatment approaches have been adapted to provide optimal therapy with minimal toxicities, for some diseases therapies continue to include potentially pulmonary toxic agents and modalities. Knowledge of these agents and an understanding of lung physiology and how it may be altered by therapy facilitate appropriate clinical care and monitoring of long-term survivors.

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