Elsevier

Seminars in Oncology

Volume 40, Issue 6, December 2013, Pages 757-773
Seminars in Oncology

Renal and Pulmonary Late Effects of Cancer Therapy

https://doi.org/10.1053/j.seminoncol.2013.09.009Get rights and content

Both the kidneys and lungs are susceptible to the toxic effects of cancer therapy, with specific chemotherapy agents, as well as radiation therapy, leading to acute toxicities and the risk for long-term dysfunction. The kidneys also are vulnerable to the direct impact of the cancer itself and to supportive care drugs such as certain anti-infectives and immunosuppressive agents, nonsteroidal anti-inflammatories, and radiocontrast media. The lungs are especially vulnerable after hematopoietic stem cell transplantation (HSCT), particularly in patients who develop chronic graft-versus-host disease. This article will discuss the epidemiology, specific risk factors, pathogenesis, natural history, recommended screening, preventive strategies, treatment, and areas for future research into renal and pulmonary toxicity in survivors of cancer.

Section snippets

Epidemiology

Renal dysfunction is an important consequence of cancer and its treatment, which may limit the ability to deliver optimal treatment and, if persistent, increase the morbidity and mortality, as well as reduce the quality of life, of long-term survivors. Even apparently reversible acute kidney injury may increase the likelihood of chronic renal disease later in life.1 Cancer itself may cause renal impairment due to renal infiltration, urinary tract obstruction, hypercalcemia, or the consequences

Epidemiology

Much of the existing knowledge about the chronic effects of cancer treatment on the lung comes from literature pertaining to studies on childhood cancer survivors. The Childhood Cancer Survivor Study (CCSS), a large retrospective cohort study of survivors of childhood and adolescent cancers, has demonstrated that the risk of pulmonary conditions is more than three times higher in cancer survivors than in their siblings.70 Lung disease may appear decades after treatment and is associated with

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    Conflicts of interest and financial disclosures: none.

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