Легочная токсичность противоопухолевого лечения у детей и подростков с лимфомой Ходжкина

Pulmonary toxicity is one of serious complications of combined modality treatment for malignant tumors. Issues of pulmonary toxicity after radiation therapy and bleomycin-included chemotherapy are considered in article. Pneumonitis developed after treatment divided into early and late, causing the deterioration of respiratory function. The article examines the emergence of pulmonary toxicity after radiotherapy and chemotherapy, especially with the inclusion of bleomycin. The most significant adverse effect of the bleomycin using is interstitial pneumonitis followed by pulmonary fibrosis, which is diagnosed in 46 % patients. The mortality of patients with bleomycin-induced pulmonitis is 3 %. The article describes the clinical manifestations of complications and methods of diagnosis. Bleomycin-associated pneumonitis diagnosed in 3-5 % patients receiving doses of ≤300 mg, and in 20 % patients after total doses ≥500 mg. In addition to the study of pulmonary function tests in the article the technique of performing CT of the chest with the construction of three-dimensional reconstructions using applications “Volume rendering”, allow to diagnose early and late pulmonary toxicity. The diagnostics of the late pulmonary toxicity are difficult because clinical symptoms are usually absent or expressed at moderate and low level. For timely diagnosis of this condition should be carefully controlled to an annual survey of laboratory tests, including spirometry and measurement of carbon monooxide diffusing capacity, as well as the control radiography and CT of the chest. The density gradient of the lung tissue is relatively small for the visual assessment of moderate diffuse pulmonary fibrosis, and the use of three-dimensional image allows you to improve the perception of the data, without the need for additional scanning study area.