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Panminerva Medica 2002 September;44(3):205-12

lingua: Inglese

Treatment-related death from chemotherapy and thoracic radiotherapy for advanced cancer

Ohe Y.

Department of Internal Medicine National Cancer Center Hospital, Chuo-ku, Tokyo, Japan


Pneumonia and ­sepsis ­during neu­tro­penia are ­common com­pli­ca­tions ­from chem­o­therapy and ­they are some­times ­lethal. Radiation pneu­mo­nitis is ­also a ­common tox­icity ­after tho­racic radio­therapy, and ­severe pneu­mo­nitis ­causes ­hypoxia and ­death. However, the inci­dence and ­risk fac­tors of treat­ment-­related ­death ­from the treat­ment of ­advanced ­cancer ­using chem­o­therapy and/or tho­racic radio­therapy are not ­well under­stood. Between July 1992 and December 1997, 1799 ­patients ­were diag­nosed as ­having ­lung ­cancer and 784 of 1799 ­patients ­received chem­o­therapy in the National Cancer Center Hospital East. Of 784 ­patients, 18 (2.3%) ­died ­from tox­icity of the ­initial chem­o­therapy. In the Japan Clinical Oncology Group (­JCOG) ­trials for ­lung ­cancer, 29 of 1176 ­patients (2.5%) ­were ­reported to ­have ­died ­from tox­icity of the treat­ments. Several ­papers ­have ­reported the ­risk fac­tors of ­early ­death ­after chem­o­therapy or treat­ment-­related ­death ­caused by chem­o­therapy in ­patients ­with ­cancer. Only ­poor per­for­mance ­status was a vig­orous ­risk ­factor. Reported mor­tality ­rates of radi­a­tion pneu­mo­nitis ­range ­from 0 to 9.9% ­from 7 ­reports and 29 of 1244 ­patients (2.3%) ­died of pneu­mo­nitis ­after tho­racic radio­therapy or chem­o­ra­dio­therapy. Our pre­vious ­report sug­gested ­that pul­mo­nary ­fibrosis iden­ti­fied on ­plain ­chest X-ray ­film is a ­very ­strong ­risk ­factor of treat­ment-­related ­death ­from radi­a­tion pneu­mo­nitis. At ­least 1-2% mor­tality ­should be ­expected for chem­o­therapy and tho­racic radio­therapy. And in ­patients ­with ­poor PS, the ­expected mor­tality ­rate ­from chem­o­therapy is ­increased.

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