BLEOMYCIN INDUCED PULMONARY TOXICITY IN PATIENTS WITH GERM CELL TUMOURS
AbstractBackground: Bleomycin is a cytotoxic drug used in treatment of Germ Cell Tumours (GCTs) and isassociated with pulmonary toxicity. Bleomycin pulmonary toxicity (BPT) manifests predominantly aspulmonary fibrosis, organising pneumonia (OP) or Nonspecific Interstitial Pneumonitis (NSIP). Ourobjectives were to determine the incidence of BPT, describe the common HRCT patterns of pulmonarytoxicity and to find out the correlation of variables (cumulative dose of bleomycin, age and glomerularfiltration rate) with pulmonary toxicity. Methods: The study included the data of 96 patients fromMarch 2006 to September 2008. All patients had histologically proven GCT and received bleomycincontaining regimes. Variables age, GFR at the time of initial presentation along with cumulative doseof bleomycin at completion of chemotherapy or at the time of BPT were recorded. The High resolutionCT chest (HRCT) of these patients was independently reviewed by two radiologists. Bleomycintoxicity was reported on the radiologic features of pulmonary fibrosis, OP or NSIP. Results: Fourteenpatients (14.6%) developed BPT. Common patterns of BPT were, pulmonary fibrosis (5.2%), OP(5.2%) and NSIP (4.2%). Using the Univariate regression analysis there was significant relationshipbetween BPT and age, cumulative bleomycin dose and initial GFR at the beginning of treatment.Conclusions: Because BPT can be progressive and fatal, early recognition is important. The diagnosisof pulmonary toxicity should be considered in any patient with new or progressive respiratorycomplaints. BPT can be difficult to diagnose; therefore, knowledge and understanding of radiologicmanifestations of toxicity caused by Bleomycin are necessary for institution of appropriate treatment.There is increasing incidence of BPT with increasing age, cumulative dose and decreasing GFR.Keywords: Bleomycin, Pulmonary toxicity, Germ cell tumours, HRCT
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