[Bleomycin-induced pulmonary infiltrations in the treatment of testicular cancer].

Under Cisplatinum/Vinblastine/Bleomycin treatment six of 82 patients with nonseminomatous testicular cancer developed a Bleomycin-induced pulmonary toxicity. After a total Bleomycin dose of 300-360 mg all six patients showed multiple nodular densities near the pleura in the basal lung areas on the computed tomographic scanning (CT). Disseminated interstitial infiltrates, mostly in the lower lung fields were spontaneously observed by means of chest X-rays in only one case. In two other cases only minimal changes were found retrospectively. In five cases the diffusion capacity did not decrease significantly. Diffusion capacity, vital capacity and oxygen fell significantly in only one case. The latter was also the only patient showing clinical symptoms. The lung changes were completely reversible in four patients 4-6 months after cessation of Bleomycin. In two patients there were reversible residual changes after a timespan of 20 and 24 months. Two patients received no further antineoplastic treatment, two were under maintenance therapy, two under further induction chemotherapy because of the assumption of lung metastases. None of the six patients show any evidence at present of testis tumor (observation period 17-34 months). It can be difficult to distinguish between Bleomycin-induced lung damage and tumor metastases by radiological means. We were able to differentiate by observing the clinical course of the six patients. In case of doubt a histological examination is strongly recommended.