Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Switzerland.
Department of Pediatric Oncology/Hematology, University Children's Hospital Basel, University of Basel, Switzerland.
Pediatr Blood Cancer. 2018 Oct;65(10):e27255. doi: 10.1002/pbc.27255. Epub 2018 Jun 15.
Childhood cancer survivors are at increased risk for pulmonary morbidity and mortality. International guidelines recommend pulmonary function tests (PFT) during follow-up care. This nationwide study assessed how many children received PFT within 5 years after pulmotoxic treatment in Switzerland, types of tests, and predictors for testing.
We included all children from the Swiss Childhood Cancer Registry who were diagnosed with cancer from 1990 to 2013 at age 0-16 years, survived for ≥2 years from diagnosis, and had pulmotoxic chemotherapy with bleomycin, busulfan, nitrosoureas, and/or chest radiotherapy. We searched medical records in all Swiss pediatric oncology clinics for PFT (spirometry, plethysmography, diffusion capacity of carbon monoxide [DLCO]) and treatment details.
We found medical records for 372 children, of whom 147 had pulmotoxic chemotherapy and 323 chest radiotherapy. Only 185 had plethysmography and/or spirometry (50%), 122 had DLCO (33%). Testing varied by cancer center from 3% to 79% (P = 0.001). Central nervous system tumor survivors and those not treated according to study protocols had less plethysmography and/or spirometry (odds ratio (OR) 0.3 and 0.3), lymphoma survivors and those who were symptomatic had more PFT (plethysmography and/or spirometry: OR 5.9 and 8.7; DLCO: OR 3.4 and 2.3). Cumulative incidence (CuI) of PFT was 52% in the first 5 years after pulmotoxic treatment; most of the tests were done in the first 2 years after treatment (CuI 44%).
Only half of the survivors exposed to pulmotoxic treatment have been followed up with PFT in Switzerland. We need to optimize, update, and implement monitoring guidelines.
儿童癌症幸存者患肺部疾病和死亡的风险增加。国际指南建议在随访期间进行肺功能检查（PFT）。这项全国性研究评估了瑞士有多少儿童在接受肺毒性治疗后 5 年内接受了 PFT，测试类型以及测试的预测因素。
我们纳入了瑞士儿童癌症登记处中所有在 1990 年至 2013 年期间诊断为 0-16 岁癌症的儿童，诊断后至少存活 2 年，接受过博来霉素、白消安、亚硝脲类药物和/或胸部放疗的肺毒性化疗。我们在所有瑞士儿科肿瘤诊所的医疗记录中搜索了 PFT（肺量计，体积描记术，一氧化碳弥散量[DLCO]）和治疗细节。
我们找到了 372 名儿童的医疗记录，其中 147 名接受了肺毒性化疗，323 名接受了胸部放疗。只有 185 名接受了体积描记术和/或肺量计检查（50％），122 名接受了 DLCO 检查（33％）。检测率因癌症中心而异，范围为 3％至 79％（P=0.001）。中枢神经系统肿瘤幸存者和未按研究方案治疗的幸存者接受的体积描记术和/或肺量计检查较少（比值比[OR]为 0.3 和 0.3），淋巴瘤幸存者和有症状的幸存者接受的 PFT 更多（体积描记术和/或肺量计：OR 为 5.9 和 8.7；DLCO：OR 为 3.4 和 2.3）。在接受肺毒性治疗后的前 5 年内，PFT 的累积发生率（CuI）为 52％；大多数检查是在治疗后 2 年内进行的（CuI 为 44％）。
在瑞士，只有一半暴露于肺毒性治疗的幸存者接受了 PFT 随访。我们需要优化、更新和实施监测指南。
