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American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 2007 Sep 01;25(25):3991-4008

Date

06/20/2007

Pubmed ID

17577017

DOI

10.1200/JCO.2007.10.9777

Scopus ID

2-s2.0-34548522479   501 Citations

Abstract

PURPOSE: To review the evidence on the incidence of long-term cardiac or pulmonary toxicity secondary to chemotherapy, radiotherapy, or trastuzumab in symptomatic and asymptomatic cancer survivors.

METHODS: An American Society of Clinical Oncology Panel reviewed pertinent information from the literature through February 2006.

RESULTS: Few studies directly addressing the benefits of screening for long-term cardiac or pulmonary toxicity in asymptomatic cancer survivors who received chemotherapy, radiotherapy, or trastuzumab were identified. The reviewed literature included primarily retrospective and cross-sectional studies describing the incidence of cardiac and pulmonary late effects. Anatomic and/or functional abnormalities have been associated with use of all currently available anthracyclines and their derivatives. Trastuzumab-related cardiac dysfunction rarely causes death, and in most cases is reversible with improvement in cardiac function on drug discontinuation and/or treatment with cardiac medications. The estimated aggregate incidence of radiation-induced cardiac disease is 10% to 30% by 5 to 10 years post-treatment, although the incidence may be lower with modern techniques. Radiation pneumonitis is reported in 5% to 15% of lung cancer patients receiving definitive external-beam radiation therapy. A minority of patients may develop progressive pulmonary fibrosis; late complications include cor pulmonale and respiratory failure. Bleomycin-induced pneumonitis is an acute rather than late effect of treatment. Late pulmonary complications in bone marrow or stem cell transplantation patients who develop interstitial pneumonitis include idiopathic pneumonia syndrome and bronchiolitis obliterans.

CONCLUSION: An increased incidence of cardiac and/or pulmonary dysfunction is observed in cancer survivors. Research is needed to identify high-risk patients, and to determine the optimal screening strategies and subsequent treatment.

Author List

Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, Hagerty KL, Somerfield MR, Vaughn DJ, ASCO Cancer Survivorship Expert Panel

Author

Cindy L. Schwartz MD, MPH Chief, Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Anthracyclines
Antineoplastic Combined Chemotherapy Protocols
Cardiovascular Diseases
Causality
Child
Comorbidity
Drug Monitoring
Evidence-Based Medicine
Female
Follow-Up Studies
Humans
Incidence
Lung Diseases
Male
Neoplasms
Prevalence
Radiotherapy
Survivors
jenkins-FCD Prod-461 7d7c6113fc1a2757d2947d29fae5861c878125ab