Primary Exposure: Pulmonary Toxic Therapy
Agents with significant pulmonary toxic properties identified from the
literature include pulmonary radiation and select chemotherapy agents
(bleomycin, busulfan, carmustine, lomustine and cyclophosphamide). While
cyclophosphamide is not traditionally considered by oncologists to be a
pulmonary toxic chemotherapy agent, it is well-reported to cause
multiple lung sequelae including early and late onset pneumonitis and
pulmonary fibrosis13. We stratified thoracic radiation
into high volume or low volume depending on the volume of lung included
in the radiation field. Mantle, mediastinum, whole lung and total body
irradiation were considered high-volume thoracic radiation, while neck,
abdominal, inverted Y, para-aortic, flank or supraclavicular radiation
were considered low volume thoracic radiation. Internationally approved
standardized pediatric oncology treatment protocols based on cancer type
and extent of disease were used for both chemotherapy and radiation
therapy. These were consistent throughout the study time period.