Ri. Jakacki et al., RESTRICTIVE LUNG-DISEASE FOLLOWING TREATMENT FOR MALIGNANT BRAIN-TUMORS - A POTENTIAL LATE EFFECT OF CRANIOSPINAL IRRADIATION, Journal of clinical oncology, 13(6), 1995, pp. 1478-1485
Purpose: To examine the effects Of lomustine (CCNU), a commonly used n
itrosurea, and craniospinal radiation therapy on the subsequent develo
pment of restrictive lung disease (RLD) following treatment for malign
ant brain tumors, Patients and Methods: Pulmonary function testing wit
h measurement of lung volume, spirometry, and diffusion capacity was p
erformed in 28 patients who had received CCNU and/or radiation therapy
as treatment for a malignant brain tumor The median age at the time o
f treatment was 11.4 years (range, 3.9 to 36.7) and radiation therapy
was completed 6 months to 11.6 years (median, 2.6 years) before testin
g, Patients were divided into four groups based On prior therapy. Grou
p 1 received involved-field irradiation and a CCNU-containing chemothe
rapy regimen (n = 7); group 2, craniospinal irradiation with a boost t
o the primary tumor site and a CCNU-containing chemotherapy regimen (n
= 6); group 3, craniospinal irradiation with a boost to the primary t
umor site and a non-CCNU containing chemotherapy regimen (n = 7); and
group 4, craniospinal irradiation with a boost to the primary tumor si
te without chemotherapy (n = 8), Results: Fourteen patients (50%) had
findings consistent with RLD, One of seven patients (14.3%) who receiv
ed CCNU without spinal irradiation had RLD, whereas 13 of 21 (61.9%) w
ho received spinal irradiation with or without CCNU had RLD (P = .038)
, including four of eight patients treated with craniospinal irradiati
on alone. Logistic regression analysis showed that only spinal irradia
tion was a significant predictor for RLD, Patients who received spinal
irradiation were 4.3 times more likely to have RLD than those who did
not receive spinal irradiation. Conclusion: Spinal irradiation may be
a risk factor for the development of RLD. (C) 1995 by American Societ
y of Clinical Oncology.