Guidelines for Complications of Cancer Treatment Vol VIII Part B

Pulmonary Toxicity of AntineoplasticTherapyMany drugs can produce damage to the lungs, airways, pleura,and pulmonary circulation. The most common are listed inTable 1.The most common pattern is interstitial lung disease(ILD). Although drug-induced ILD accounts for only 3% ofall causes of ILD, it represents an important subtype of thisdisorder, since discontinuation of the medicine may lead tosignificant improvement 1 .The diagnosis of cytotoxic lung damage depends upon anappropriate history of drug exposure, histological evidenceof lung injury, and exclusion of other causes of pulmonarydisease. Because there is no single diagnostic test capable ofdefinitively confirming the diagnosis of chemotherapyassociatedpulmonary toxicity, it remains a diagnosis ofexclusion 2 .The typical clinical presentation in patients with chemotherapyinducedpulmonary fibrosis is the insidious onset of dyspnoeaand nonproductive cough. Fever is common but notconsistently present and chills are usually absent. Physicalexamination usually reveals crackles. The chest radiographmay be initially unremarkable for weeks before the typicaldiffuse interstitial infiltrative pattern appears. The only specific441