LATE CARMUSTINE LUNG FIBROSIS - AGE AT TREATMENT MAY INFLUENCE SEVERITY AND SURVIVAL

Previously, we have reported in 1990 that 35% of carmustine treated pa tients (6 of 17) who survived childhood brain tumors died of pulmonary fibrosis between 2 and 13 years after treatment, In addition, 8 patie nts studied in 1989 (13 to 17 years post treatment), had physiologic a nd biopsy or radiologic evidence of pulmonary fibrosis, We now report 3 more years of follow-up on these patients, Between 1989 and 1992, tw o more patients have died of pulmonary fibrosis, giving an overall mor tality of 47%. Of the eight patients who died of pulmonary fibrosis, t he median age at treatment was 2.5 years, whereas the nine long-term s urvivors had a median age at treatment of 10 years. All five patients treated below the age of 5 years have died of lung fibrosis, Analysis by the standard survival curve method indicated that patients treated at an age less than 6 years were more likely to die than those treated at an age older than 7 years (p=0.03), Of the nine survivors, seven w ere observed over 3 more years, There was a gradual decline in mean fo rced vital capacity from 55% predicted (range, 44 to 81) to 51% predic ted (range, 41 to 72) and total lung capacity fell from 65% predicted (range, 51 to 89) to 57% predicted (range, 47 to 77).