RESTRICTIVE LUNG-DISEASE FOLLOWING TREATMENT FOR MALIGNANT BRAIN-TUMORS - A POTENTIAL LATE EFFECT OF CRANIOSPINAL IRRADIATION

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.