A prospective study of pulmonary function in patients receiving mitomycin
A prospective study of pulmonary function in patients receiving mitomycin
复制标题
DOI：
10.1378/chest.109.4.939
复制
发表时间：
1996-04-01
期刊：
影响因子：
9.6
通讯作者：
Jett, JR
中科院分区：
文献类型：
--
作者：
Castro, M;Veeder, MH;Jett, JR
丝裂霉素是一种用于治疗多种实体瘤的化疗剂。这种药物的肺毒性反应可能危及生命。我们前瞻性地研究了肺功能试验（PFT）在监测丝裂霉素肺毒性发生中的作用。在基线和丝裂霉素治疗三个周期后获得PFT。我们分析了133例转移性肺鳞状细胞癌患者的临床过程、放射学研究和PFT结果，这些患者随机接受丝裂霉素、长春碱和顺铂或单独使用丝裂霉素治疗，作为北中央癌症治疗组（NCCTG）前瞻性治疗方案的一部分。由于基础疾病的高进展率和死亡率，第三个周期后仅40例患者的弥散量（Dco）可用。三个周期化疗后，40例患者中有11例（28%）的Dco平均下降14%（校正血红蛋白后变化20%）。Dco的下降与预后不良无关（p=0.77），7例患者（5%）发生了归因于化疗的重度肺毒性反应，包括非心源性肺水肿、间质性肺炎和胸腔积液。皮质类固醇治疗导致暂时的主观改善3例。在这7例患者中，Dco与肺毒性反应的发生无关。总之，（1）丝裂霉素引起的具有临床意义的肺毒性反应的发生率相对较低（5%），（2）丝裂霉素治疗导致约四分之一接受3个周期化疗的患者的Dco下降超过20%，（3）在接受丝裂霉素治疗的患者中使用系列PFT不能预测肺毒性。
Mitomycin is a chemotherapeutic agent that is used to treat a variety of solid tumors. Pulmonary toxic reactions from this agent can be life threatening. We prospectively investigated the utility of pulmonary function tests (PFTs) in monitoring for the occurrence of pulmonary toxicity due to mitomycin. PFTs were obtained at baseline and after three cycles of mitomycin therapy. We analyzed the clinical course, radiologic studies, and PFT results in 133 patients with metastatic squamous cell carcinoma of the lung randomized to treatment with either mitomycin, vinblastine, and cisplatin or mitomycin alone as part of a prospective treatment protocol of the North Central Cancer Treatment Group (NCCTG). The diffusing capacity (Dco) was available in only 40 patients after the third cycle due to a high rate of progression and death from their underlying disease. After three cycles of chemotherapy, there was an average decline in the Dco of 14% (p20% change after correcting for hemoglobin) was noted in 11 of 40 patients (28%). This decline in the Dco was not associated with a worse prognosis (p=0.77), Seven patients (5%) developed severe pulmonary toxic reactions attributed to chemotherapy, including noncardiogenic pulmonary edema, interstitial pneumonitis, and pleural effusions. Corticosteroid therapy resulted in temporary subjective improvement in three patients. The Dco did not correlate with the development of pulmonary toxic reactions in these seven patients. In conclusion, (1) the incidence of clinically significant pulmonary toxic reactions from mitomycin is relatively low (5%), (2) mitomycin therapy resulted in a greater than 20% decline in the Dco in approximately one-fourth of patients receiving three cycles of chemotherapy, and (3) the use of serial PFTs in patients receiving mitomycin was not shown to be predictive of pulmonary toxicity.