PULMONARY TOXICITY OF HIGH-DOSE CHEMOTHERAPY FOR BREAST-CANCER - A NONINVASIVE APPROACH TO DIAGNOSIS AND TREATMENT

Drug-induced pulmonary toxicity is one of the most frequent non-hemato logic toxicities in breast cancer patients receiving high-dose chemoth erapy with cyclophosphamide, cisplatin and BCNU (CY/CDDP/BCNU), A non- invasive clinical scoring system was utilized in an attempt to diagnos e and treat early lung toxicity in 64 consecutive breast cancer patien ts undergoing CY/CDDP/BCNU supported by peripheral blood progenitor ce lls, Following hospital discharge, patients who developed symptoms sug gestive of lung toxicity were evaluated with physical examination, DLC O, 2-min walking oximetry and a chest radiograph, Clinically weighted scores were assigned as follows: crackles on lung exam, 2; decrease in corrected DLCO by >10% from baseline, 3; decrease in O-2 saturation b y greater than or equal to 4% with a 2-min walk, 3; and interstitial i nfiltrates on chest radiograph, 3, Patients with scores greater than o r equal to 6 were treated with prednisone (60 mg p.o. twice a day foll owed by a 2-month taper), Treatment was instituted in 37 patients (58% ) a median of 56 days after high-dose chemotherapy, Steroid therapy wa s associated with rapid clinical improvement in most patients, No fata l complications or chronic pulmonary fibrosis was seen, This non-invas ive clinical scoring system can be utilized as a model for the early d iagnosis of lung toxicity, Further investigation is warranted for the development of preventative measures against this syndrome.