PULMONARY COMPLICATIONS OF CANCER THERAPY

Abstract

Both the incidence and the spectrum of lung disease caused by cancer therapy have steadily expanded as increasingly aggressive regimens have been implemented. Two of the major treatment modalities, chemotherapy and radiotherapy, are often limited by the development of significant pulmonary complications. All tissues of the body are susceptible to injury by these treatment modalities; however, the lungs are particularly vulnerable. Two potentially fatal complications of cytotoxin- and radiation-induced lung damage have been recognized: interstitial pneumonitis and pulmonary fibrosis. Other clinical syndromes have also been identified, including alveolar lipoproteinosis, pulmonary veno-occlusive disease, hypersensitivity pneumonitis, noncardiogenic pulmonary edema, obliterative bronchiolitis, and pleural diseases. This article reviews current knowledge of pulmonary toxicity owing to cancer therapy. The intent is not to present an encyclopedic treatise of all of the cytotoxic drugs that have been reported to cause adverse pulmonary effects. Instead, only those chemotherapeutic agents known to cause clinically relevant syndromes of pulmonary damage are presented. These agents are listed in Table 1. Radiotherapy may also be complicated by lung toxicity. Damage caused by this therapeutic modality is also discussed.