title: Dactinomycin potentiation of radiation pneumonitis: a forgotten interaction.
abstract: No mention of dactinomycin potentiation of pulmonary radiation was found in a review of the literature of the past 12 years. Before that, this complication was well described and investigators had calculated that dactinomycin increased the toxic effect of lung radiation by a factor of 1.3 and reduced the radiation tolerance of the lung by at least 20%. An example of such a toxic effect is described in the treatment of a 7-year-old girl with lung metastases from Ewing's sarcoma. The chemotherapy protocol followed contained cyclophosphamide, vincristine, dactinomycin, adriamycin, cisplatinum, VP16, and radiotherapy. The treatment was associated with fatal pulmonary fibrosis following the reintroduction of dactinomycin after radiotherapy. Our experience suggests that there is clinical significance to this complication in sarcoma therapy when dactinomycin-containing protocols are used with radiation in the treatment of pulmonary metastases.
authors.affiliation: Sambur Center for Pediatric Hematology/Oncology, Beilinson Medical Center, Petah Tiqva, Israel.
authors.forename: I J
authors.initials: IJ
authors.lastname: Cohen
authors.forename: D
authors.initials: D
authors.lastname: Loven
authors.forename: T
authors.initials: T
authors.lastname: Schoenfeld
authors.forename: J
authors.initials: J
authors.lastname: Sandbank
authors.forename: C
authors.initials: C
authors.lastname: Kaplinsky
authors.forename: Y
authors.initials: Y
authors.lastname: Yaniv
authors.forename: L
authors.initials: L
authors.lastname: Jaber
authors.forename: R
authors.initials: R
authors.lastname: Zaizov
mesh_terms: D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects* / Q000633:toxicity; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005266:Femoral Neoplasms / Q000188:drug therapy*; D006801:Humans; D008168:Lung / Q000378:metabolism / Q000528:radiation effects; D008175:Lung Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000532:radiotherapy; D051379:Mice; D011658:Pulmonary Fibrosis / Q000209:etiology*; D011833:Radiation Injuries, Experimental / Q000139:chemically induced; D011836:Radiation Tolerance / Q000187:drug effects; D011878:Radiotherapy / Q000009:adverse effects*; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000378:metabolism* / Q000532:radiotherapy; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin