title: Late carmustine lung fibrosis. Age at treatment may influence severity and survival.
abstract: Previously, we have reported in 1990 that 35% of carmustine treated patients (6 of 17) who survived childhood brain tumors died of pulmonary fibrosis between 2 and 13 years after treatment. In addition, 8 patients studied in 1989 (13 to 17 years post treatment), had physiologic and biopsy or radiologic evidence of pulmonary fibrosis. We now report 3 more years of follow-up on these patients. Between 1989 and 1992, two more patients have died of pulmonary fibrosis, giving an overall mortality of 47%. Of the eight patients who died of pulmonary fibrosis, the median age at treatment was 2.5 years, whereas the nine long-term survivors 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 were observed over 3 more years. There was a gradual decline in mean forced vital capacity from 55% predicted (range, 44 to 81) to 51% predicted (range, 41 to 72) and total lung capacity fell from 65% predicted (range, 51 to 89) to 57% predicted (range, 47 to 77).
authors.affiliation: North West Lung Centre, Wythenshawe Hospital, Manchester, England.
authors.forename: B R
authors.initials: BR
authors.lastname: O'Driscoll
authors.forename: S
authors.initials: S
authors.lastname: Kalra
authors.forename: H R
authors.initials: HR
authors.lastname: Gattamaneni
authors.forename: A A
authors.initials: AA
authors.lastname: Woodcock
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001932:Brain Neoplasms / Q000188:drug therapy*; D002330:Carmustine / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D011658:Pulmonary Fibrosis / Q000139:chemically induced* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D017741:Survivors; D014109:Total Lung Capacity
chemical_list: D002330:Carmustine