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March 15, 1976

Large-Dose Bleomycin Therapy and Pulmonary Toxicity: A Possible Role of Prior Radiotherapy

Author Affiliations

From the Department of Medicine (Drs Samuels, Holoye, and Lanzotti) and the Department of Surgery (Dr Johnson), the University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute at Houston.

JAMA. 1976;235(11):1117-1120. doi:10.1001/jama.1976.03260370025026

Bleomycin sulfate pulmonary toxicity was encountered in nine of 101 patients receiving high-dose therapy for widespread testicular cancer. The pulmonary presentation was separable into two categories: (1) an early or minimal form with dyspnea on exertion, minimal roentgenographic findings, and normal arterial partial pressure of oxygen at rest and (2) a severe form, with prominent roentgenographic findings and hypoxemia at rest. All five patients with the severe form died, while the remaining four patients with the minimal presentation recovered. Prior thoracic radiotherapy appeared to predispose to bleomycin pulmonary toxicity, as this complication developed in five of 12 patients receiving prior chest radiotherapy vs four 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 chemotherapy in metastatic testicular cancer.

(JAMA 235:1117-1120, 1976)