Guidelines for Complications of Cancer Treatment Vol VIII Part B

study involving 105 patients was 8.6%. Patients presented withfever, hypoxemia, and infiltrates in the radiograph. Symptomsdeveloped from 3 days after initiating therapy to 6 days afterthe seventh cycle. Trail of corticosteroids is beneficial in somecases & it should be tried 11Busulfan: It was the first cytotoxic drug associated with thedevelopment of pulmonary toxicity. The onset of respiratorysymptoms may occur from 6 weeks to 10 years followingexposure to busulfan, with most cases occurring within 3.5years 12 . The most common symptoms include dyspnea, drycough, weight loss, and fever over a period of weeks to months.The withdrawal of the offending medicine should be donepromptly and the use of corticosteroids has been associatedwith anedoctal responses. Once pulmonary toxicity develops,the prognosis is usually poor, with most patients developingprogressive respiratory failure with eventual death. The mediansurvival for these patients is approximately 5 months 13Carmustine: Possible risk factors for the development ofpulmonary toxicity in patients receiving carmustine-basedchemotherapy include preexisting pulmonary disease, a historyof smoking, and thoracic radiation. In a study involving longtermsurvivors from childhood brain tumors, the mortality ratewas 12% for early pulmonary fibrosis, defined as diseasepresenting within 3 years of exposure to carmustine, and 35%for late fibrosis, defined as disease appearing after 8 to 20years 14 .To summarizeSymptoms of pulmonary toxicities are nonspecific andfrequently misinterpreted as caused by the underlying disorder,particularly in patients with thoracic malignancies. The lackof a pathognomonic diagnostic test makes it essentially adiagnosis of. exclusion Treatment usually consists ofwithdrawal of the suspected offending agent and the use of444