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Benign and malignant pulmonary parenchymal findings on chest CT among adult survivors of childhood and young adult cancer with a history of chest radiotherapy

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Abstract

Purpose

Childhood and young adult cancer survivors exposed to chest radiotherapy are at increased risk of lung cancer. In other high-risk populations, lung cancer screening has been recommended. Data is lacking on prevalence of benign and malignant pulmonary parenchymal abnormalities in this population.

Methods

We conducted a retrospective review of pulmonary parenchymal abnormalities in chest CTs performed more than 5 years post-cancer diagnosis in survivors of childhood, adolescent, and young adult cancer. We included survivors exposed to radiotherapy involving the lung field and followed at a high-risk survivorship clinic between November 2005 and May 2016. Treatment exposures and clinical outcomes were abstracted from medical records. Risk factors for chest CT–detected pulmonary nodule were assessed.

Results

Five hundred and ninety survivors were included in this analysis: median age at diagnosis, 17.1 years (range, 0.4–39.8); and median time since diagnosis, 22.3 years (range, 1–58.6). At least one chest CT more than 5 years post-diagnosis was performed in 338 survivors (57%). Among these, 193 (57.1%) survivors had at least one pulmonary nodule detected on a total of 1057 chest CTs, resulting in 305 CTs with 448 unique nodules. Follow-up was available for 435 of these nodules; 19 (4.3%) were malignant. Risk factors for first pulmonary nodule were older age at time of CT, CT performed more recently, and splenectomy.

Conclusions

Benign pulmonary nodules are very common among long-term survivors of childhood and young adult cancer.

Implications for Cancer Survivors

High prevalence of benign pulmonary nodules in cancer survivors exposed to radiotherapy could inform future guidelines on lung cancer screening in this population.

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Abbreviations

CT:

Computed tomography

CI:

Confidence interval

LTFU:

Long-Term Follow-Up

LDCT:

Low-dose computed tomography

MSKCC:

Memorial Sloan Kettering Cancer Center

PY:

Pack-years

PR:

Prevalence risk

USPSTF:

United States Preventive Service Task Force

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Funding

This work was supported by the Meg Berté Owen Fund, the National Institutes of Health (K05CA160724; P30 CA008748).

Author information

Author notes

  1. Dana Barnea and Emily S. Tonorezos contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel Aviv, Israel

    Dana Barnea

  2. Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    Emily S. Tonorezos

  3. Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center-Albert Einstein College of Medicine, New York, NY, USA

    Amber Khan

  4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Joanne F. Chou & Chaya S. Moskowitz

  5. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Rana Kaplan

  6. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Suzanne L. Wolden

  7. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Yolanda Bryce

  8. Department of Medicine, Duke University, Durham, NC, USA

    Kevin C. Oeffinger

Authors
  1. Dana Barnea
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  2. Emily S. Tonorezos
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Contributions

D.B., E.S.T., C.S.M., and K.C.O. contributed to the conception and design. D.B., E.S.T., J.C., C.S.M., A.K., S.L.W., Y.B., and K.C.O. contributed to the acquisition, analysis, and interpretation. D.B., E.S.T, J.C., and K.C.O. drafted the manuscript. All authors revised the article for important intellectual content and final approval. D.B. is the guarantor of the paper, taking responsibility for the integrity of the work, from inception to published article.

Corresponding author

Correspondence to Dana Barnea.

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Conflict of interest

Authors Dana Barnea, Emily S. Tonorezos, Amber Khan, Joanne F. Chou, Chaya S. Moskowitz, Rana Kaplan, and Suzanne L. Wolden declare they have no financial interests. Author Kevin C. Oeffinger is on the advisory board of Grail, LLC. Author Yolanda Bryce is a consultant for Hologic, Inc. and speaker for Boston Scientific and Pfizer, Canada.

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This study has been presented in part as a poster presentation in the 2017 Cancer Survivorship Symposium: Advancing Care and Research in San Diego, CA, USA, 26–27 Jan, 2017.

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Barnea, D., Tonorezos, E.S., Khan, A. et al. Benign and malignant pulmonary parenchymal findings on chest CT among adult survivors of childhood and young adult cancer with a history of chest radiotherapy. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01405-1

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  • DOI: https://doi.org/10.1007/s11764-023-01405-1

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