title: Pulmonary outcomes in survivors of childhood cancer: a systematic review.
abstract: BACKGROUND
  The purpose of this article is to summarize the literature that documents the long-term impact of cancer treatment modalities on pulmonary function among survivors of cancer and to identify potential areas for further research.
  
  
  METHODS
  Systematic reviews of clinical trials, observational studies, case series, and review articles were conducted. Articles were limited to the studies that discussed pulmonary toxicity or late effects among pediatric cancer survivors and to follow-up investigations that were conducted a minimum of 2 years after completion of cancer-related treatment or 1 year after hematopoietic stem cell transplant.
  
  
  RESULTS
  Sixty publications (51 clinical studies/reports and nine reviews) published from January 1970 to June 2010 in PubMed met the inclusion criteria. Data showed an association between radiotherapy, alkylating agents, bleomycin, hematopoietic stem cell transplant, and thoracic surgery and pulmonary toxicity, as well as possible interactions among these modalities.
  
  
  CONCLUSIONS
  Pulmonary toxicity is a common long-term complication of exposure to certain anticancer therapies in childhood and can vary from subclinical to life threatening. Pulmonary function and associated loss of optimal exercise capacity may have adverse effects on long-term quality of life in survivors. Lung function diminishes as a function of normal aging, and the effects of early lung injury from cancer therapy may compound these changes. The information presented in this review is designed to provide a stimulus to promote both observational and interventional research that expands our knowledge and aids in the design of interventions to prevent or ameliorate pulmonary late effects among survivors of childhood cancer.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN. Electronic address: tseng.huang@stjude.org.
authors.forename: Tseng-Tien
authors.initials: TT
authors.lastname: Huang
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.affiliation: Department of Pediatric Pulmonary Medicine, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Stokes
authors.affiliation: Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Krasin
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Spunt
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D007223:Infant; D008168:Lung / Q000187:drug effects / Q000503:physiopathology* / Q000528:radiation effects; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult