Skip to main content
SpringerLink
Log in

Late pulmonary complications related to cancer treatment in children

  • Thoracic imaging
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

As the number of childhood cancer survivors increases, a heightened awareness and recognition of therapy-related late effects is becoming more important. Pulmonary complications are the third leading cause of late mortality in cancer survivors. Diagnosis of these complications on chest imaging helps facilitate prompt treatment to mitigate adverse outcomes. In this review, we summarize the imaging of late pulmonary complications of cancer therapy in children and highlight characteristic findings that should be recognized by radiologists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. CureSearch for Children’s Cancer (2020) Number of diagnoses. CureSearch website. https://curesearch.org/understanding-childrens-cancer/childhood-cancer-statistics/number-of-diagnoses/. Accessed 30 Jun 2021

  2. CureSearch for Children’s Cancer (2020) 5-year survival rate. CureSearch website. https://curesearch.org/5-Year-Survival-Rate/. Accessed 30 Jun 2021

  3. American Cancer Society (2019) Cancer treatment & survivorship facts & figures 2019–2021. ACS website. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-treatment-and-survivorship-facts-and-figures-2019-2021.pdf. Accessed 20 Apr 2022

  4. Armstrong GT, Leisenring W, Gibson TM et al (2016) Reduction in late mortality among 5-year survivors of childhood cancer. N Engl J Med 374:833–842

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Astashchanka A, Ryan J, Lin E et al (2021) Pulmonary complications in hematopoietic stem cell transplant recipients — a clinician primer. J Clin Med 10:3227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. American College of Radiology (2019) ACR–ASER–SCBT–MR–SPR practice parameter for the performance of pediatric computed tomography (CT). https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CT-Ped.pdf. Accessed 30 Jun 2021

  7. Bankier AA, Van Muylem A, Knoop C et al (2001) Bronchiolitis obliterans syndrome in heart-lung transplant recipients: diagnosis with expiratory CT. Radiology 218:533–539

    Article  CAS  PubMed  Google Scholar 

  8. Barker AF, Bergeron A, Rom WN, Hertz MI (2014) Obliterative bronchiolitis. N Engl J Med 370:1820–1828

    Article  CAS  PubMed  Google Scholar 

  9. Sodhi KS, Sharma M, Lee EY et al (2018) Diagnostic utility of 3T lung MRI in children with interstitial lung disease. Acad Radiol 25:380–386

    Article  PubMed  Google Scholar 

  10. Serai SD, Rapp JB, States LJ et al (2021) Pediatric lung MRI: currently available and emerging techniques. AJR Am J Roentgenol 216:781–790

    Article  PubMed  Google Scholar 

  11. Reißig A, Kroegel C (2003) Transthoracic sonography of diffuse parenchymal lung disease. J Ultrasound Med 22:173–180

    Article  PubMed  Google Scholar 

  12. Yan J-H, Pan L, Gao Y-B et al (2021) Utility of lung ultrasound to identify interstitial lung disease: an observational study based on the STROBE guidelines. Medicine 100:e25217

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Flowers MED, Inamoto Y, Carpenter PA et al (2011) Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graft-versus-host disease according to National Institutes of Health consensus criteria. Blood 117:3214–3219

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Jagasia MH, Greinix HT, Arora M et al (2015) National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant 21:389–401e1

    Article  PubMed  Google Scholar 

  15. Filipovich AH, Weisdorf D, Pavletic S et al (2005) National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant 11:945–956

    Article  PubMed  Google Scholar 

  16. Nishio N, Yagasaki H, Takahashi Y et al (2009) Late-onset non-infectious pulmonary complications following allogeneic hematopoietic stem cell transplantation in children. Bone Marrow Transplant 44:303–308

    Article  CAS  PubMed  Google Scholar 

  17. Duncan CN, Buonanno MR, Barry EV et al (2008) Bronchiolitis obliterans following pediatric allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 41:971–975

    Article  CAS  PubMed  Google Scholar 

  18. L’excellent S, Yakouben K, Delclaux C et al (2019) Lung evaluation in 10 year survivors of pediatric allogeneic hematopoietic stem cell transplantation. Eur J Pediatr 178:1833–1839

    Article  PubMed  Google Scholar 

  19. Broglie L, Fretham C, Al-Seraihy A et al (2019) Pulmonary complications in pediatric and adolescent patients following allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 25:2024–2030

    Article  PubMed  PubMed Central  Google Scholar 

  20. Baque-Juston M, Pellegrin A, Leroy S et al (2014) Organizing pneumonia: what is it? A conceptual approach and pictorial review. Diagn Interv Imaging 95:771–777

    Article  CAS  PubMed  Google Scholar 

  21. Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M et al (2011) Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest 139:893–900

    Article  PubMed  Google Scholar 

  22. Faria IM, Zanetti G, Barreto MM et al (2015) Organizing pneumonia: chest HRCT findings. J Bras Pneumol 41:231–237

    Article  PubMed  PubMed Central  Google Scholar 

  23. Long NM, Plodkowski AJ, Schor-Bardach R et al (2017) Computed tomographic appearance of organizing pneumonia in an oncologic patient population. J Comput Assist Tomogr 41:437–441

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cordier J-F (2000) Organising pneumonia. Thorac Surg Clin 55:318–328

    CAS  Google Scholar 

  25. Samarelli AV, Tonelli R, Marchioni A et al (2021) Fibrotic idiopathic interstitial lung disease: the molecular and cellular key players. Int J Mol Sci 22:8952

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Elbahlawan L, Rains KJ, Stokes DC (2017) Respiratory care considerations in the childhood cancer patient. Respir Care 62:765–775

    Article  PubMed  Google Scholar 

  27. Peña E, Souza CA, Escuissato DL et al (2014) Noninfectious pulmonary complications after hematopoietic stem cell transplantation: practical approach to imaging diagnosis. Radiographics 34:663–683

    Article  PubMed  Google Scholar 

  28. Goske MJ, Applegate KE, Boylan J et al (2008) The ‘Image Gently’ campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol 38:265–269

    Article  PubMed  Google Scholar 

  29. Carlberg V, Simons E, Delano S, Huang JT (2017) Pediatric graft-versus-host disease. In: Cotliar JA (ed) Atlas of graft-versus-host disease: approaches to diagnosis and treatment. Springer International Publishing, Cham, pp 105–123

    Chapter  Google Scholar 

  30. Moon MH, Sa YJ, Cho KD et al (2010) Thoracic air-leak syndromes in hematopoietic stem cell transplant recipients with graft-versus-host disease: a possible sign for poor response to treatment and poor prognosis. J Korean Med Sci 25:658

    Article  PubMed  PubMed Central  Google Scholar 

  31. Vogel M, Brodoefel H, Bethge W et al (2006) Spontaneous thoracic air-leakage syndrome in patients following allogeneic hematopoietic stem cell transplantation: causes, CT-follow up and patient outcome. Eur J Radiol 60:392–397

    Article  PubMed  Google Scholar 

  32. Liu Y-C, Chou Y-H, Ko P-S et al (2019) Risk factors and clinical features for post-transplant thoracic air-leak syndrome in adult patients receiving allogeneic haematopoietic stem cell transplantation. Sci Rep 9:11795

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Boghanim T, Murris M, Lamon T et al (2019) Thoracic air-leak syndrome complicating allogeneic hematopoietic stem-cell transplantation. Lung 197:101–103

    Article  PubMed  Google Scholar 

  34. Beck JD, Bokemeyer C, Langer T (2021) Late treatment effects and cancer survivor care in the young: from childhood to early adulthood. Springer International Publishing, Cham

    Book  Google Scholar 

  35. Benveniste MF, Gomez D, Carter BW et al (2019) Recognizing radiation therapy–related complications in the chest. Radiographics 39:344–366

    Article  PubMed  Google Scholar 

  36. Huang T-T, Hudson MM, Stokes DC et al (2011) Pulmonary outcomes in survivors of childhood cancer: a systematic review. Chest 140:881–901

    Article  PubMed  PubMed Central  Google Scholar 

  37. Travis WD, Costabel U, Hansell DM et al (2013) An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188:733–748

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nguyen HN, Das S, Gazzaneo MC et al (2019) Clinico-radiologic features of pleuroparenchymal fibroelastosis in children. Pediatr Radiol 49:1163–1170

    Article  PubMed  Google Scholar 

  39. Reddy TL, Tominaga M, Hansell DM et al (2012) Pleuroparenchymal fibroelastosis: a spectrum of histopathological and imaging phenotypes. Eur Respir J 40:377–385

    Article  PubMed  Google Scholar 

  40. Becker CD, Gil J, Padilla ML (2008) Idiopathic pleuroparenchymal fibroelastosis: an unrecognized or misdiagnosed entity? Mod Pathol 21:784–787

    Article  CAS  PubMed  Google Scholar 

  41. Von Thüsen D, Hansell JH, Tominaga DM et al (2011) Pleuroparenchymal fibroelastosis in patients with pulmonary disease secondary to bone marrow transplantation. Mod Pathol 24:1633–1639

    Article  PubMed  Google Scholar 

  42. Von der Thusen J (2013) Pleuroparenchymal fibroelastosis: its pathological characteristics. Curr Respir Med Rev 9:238–247

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Sugino K, Shimizu H, Nakamura Y et al (2018) Clinico-radiological features and efficacy of anti-fibrotic agents in atypical idiopathic pulmonary fibrosis. J Thorac Dis 10:899–908

    Article  PubMed  PubMed Central  Google Scholar 

  44. Boerner EB, Costabel U, Wessendorf TE et al (2017) Idiopathic pleuroparenchymal fibroelastosis (PPFE) — a case study of a rare entity. Rev Port Pneumol 23:352–355

    CAS  PubMed  Google Scholar 

  45. Sato S, Hanibuchi M, Takahashi M et al (2016) A patient with idiopathic pleuroparenchymal fibroelastosis showing a sustained pulmonary function due to treatment with pirfenidone. Intern Med 55:497–501

    Article  CAS  PubMed  Google Scholar 

  46. Watanabe K (2013) Pleuroparenchymal fibroelastosis: its clinical characteristics. Curr Respir Med Rev 9:229–237

    Article  CAS  PubMed Central  Google Scholar 

  47. Paulino AMC, Fowler BZ (2005) Secondary neoplasms after radiotherapy for a childhood solid tumor. Pediatr Hematol Oncol 22:89–101

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Akshay Sharma has received a consultant fee from Spotlight Therapeutics and Medexus Inc. He has also received research funding from CRISPR Therapeutics and honoraria from Vindico Medical Education.

Author information

Authors and Affiliations

  1. Edward B. Singleton Department of Radiology, Texas Children’s Hospital, 6701 Fannin St., Houston, TX, 77030, USA

    HaiThuy N. Nguyen & R. Paul Guillerman

  2. Department of Radiology, Baylor College of Medicine, Houston, TX, USA

    HaiThuy N. Nguyen & R. Paul Guillerman

  3. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA

    Morgan P. McBee

  4. Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    Morgan P. McBee

  5. Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Cara E. Morin

  6. Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Akshay Sharma

  7. Department of Pathology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA

    Kalyani R. Patel

  8. Department of Pediatrics, Pulmonology Division, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA

    Manuel Silva-Carmona

Authors
  1. HaiThuy N. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Morgan P. McBee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cara E. Morin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akshay Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kalyani R. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Manuel Silva-Carmona
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Paul Guillerman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to HaiThuy N. Nguyen.

Ethics declarations

Conflicts of interest

Akshay Sharma is the St. Jude Children’s Research Hospital site principal investigator of clinical trials for genome editing of sickle cell disease sponsored by Vertex Pharmaceuticals/CRISPR Therapeutics (NCT03745287) and by Novartis (NCT04443907). The industry sponsors provide funding for the clinical trial, which includes salary support paid to Dr. Sharma’s institution. These disclosures are not directly related to the content in this manuscript. Dr. Sharma acknowledges support from the American Society of Hematology (ASH) Scholar Award. The other authors report no conflicts.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, H.N., McBee, M.P., Morin, C.E. et al. Late pulmonary complications related to cancer treatment in children. Pediatr Radiol 52, 2029–2037 (2022). https://doi.org/10.1007/s00247-022-05391-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-022-05391-x

Keywords

Search

Navigation