J Korean Med Sci.  2010 Feb;25(2):240-244. 10.3346/jkms.2010.25.2.240.

Pulmonary Toxicity after a Quick Course of Combinatorial Vincristine, Bleomycin, and Cisplatin Neoadjuvant Chemotherapy in Cervical Cancer

• Ki KD
• Lee JM
• Lee SK
• Tong SY
• Huh CY
• Ryu JK
• Kim KY

• KMID: 1779254
• DOI: http://doi.org/10.3346/jkms.2010.25.2.240

Abstract

Pulmonary toxicity is one of the most serious adverse effects associated with a quick course of vincristine, bleomycin, and cisplatin neoadjuvant chemotherapy (NAC-VBP). The aim of this study was to evaluate pulmonary toxicity related to a quick course NAC-VBP. A total of consecutive 61 patients, who underwent at most 3 cycles of NAC-VBP every 10 days in the International Federation of Gynecology and Obstetrics (FIGO) stage IB-IIB cervical cancer from 1995 to 2007, were retrospectively analyzed. Of the 61 study subjects, 7 (11.5%) were identified to have pulmonary toxicity and 2 (3.3%) died of pulmonary fibrosis progression despite aggressive treatment and the use of a multidisciplinary approach. No factor predisposing pulmonary toxicity was identified. Initial symptoms were non-specific, but bronchiolitis obliterans organizing pneumonia and interstitial pneumonitis were characteristic findings by high-resolution computed tomography of the chest. The benefit of steroid therapy was uncertain and was associated with steroid-induced diabetes mellitus requiring insulin therapy in two patients. Fatal pulmonary toxicity is a major concern of a quick course NAC-VBP. In conclusion, these patients require special monitoring for bleomycin-induced pulmonary toxicity.

Keyword

Uterine Cervical Neoplasms; Neoadjuvant Therapy; Bleomycin; Drug Toxicity

MeSH Terms

Aged
Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*adverse effects/therapeutic use
Bleomycin/administration & dosage/*adverse effects/therapeutic use
Cisplatin/administration & dosage/*adverse effects/therapeutic use
Female
Humans
Lung Diseases/*chemically induced/pathology
Middle Aged
*Neoadjuvant Therapy
Pulmonary Fibrosis/chemically induced/mortality/pathology
Retrospective Studies
Tomography, X-Ray Computed
Uterine Cervical Neoplasms/complications/*drug therapy
Vincristine/administration & dosage/*adverse effects/therapeutic use
Bleomycin
Cisplatin
Vincristine

Figure

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  Fig. 1 Case 6, Chest HR-CT of 1 week after surgery revealing bronchiolitis obliterans organizing pneumonia.

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  Fig. 2 Case 7, Chest HR-CT of 2 month after surgery revealing diffuse alveolar damage with underlying interstitial lung disease.

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  Fig. 3 Case 2, Photomicrograph revealing interstitial widening with chronic inflammatory cell infiltration and foci of intraalveolar fibroblastic plugs (H&E stain, ×100), Lung biopsy.

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