Large-dose bleomycin therapy and pulmonary toxicity. A possible role of prior radiotherapy

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Abstract
Bleomycin sulfate pulmonary toxicity was encountered in 9 of 101 patients receiving high-dose therapy for widespread testicular cancer. The pulmonary presentation was separable into 2 categories: an early or minimal form with dyspnea on exertion, minimal roentgenographic findings, and normal arterial partial pressure O2 at rest and a severe form, with prominent roentgenographic findings and hypoxemia at rest. All 5 patients with the severe form died, while the remaining 4 patients with the minimal presentation recovered. Prior thoracic radiotherapy appeared to predispose to bleomycin pulmonary toxicity, as this complication developed in 5 of 12 patients receiving prior chest radiotherapy vs 4 of 89 not receiving radiotherapy (P < .001). The fatality rate of 5% with high-dose bleomycin therapy is acceptable in view of the 75% response rate and substantially improved survival achieved with bleomycin combination chemotheapy in metastatic testicular cancer.

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