abstract: Bleomycin-Induced Pneumonitis in the Treatment of Ovarian Sex Cord-Stromal Tumors: A Systematic Review and Meta-analysis
OBJECTIVE:
Adult
ovarian sex cord-stromal tumors (SCSTs) are a rare histological subtype of
ovarian cancer
associated with a favorable prognosis. Bleomycin-containing regimens
are standards of care, although
pneumonitis may cause potentially fatal
dose-limiting toxicity. We aimed to evaluate the safety of bleomycin in
SCST treatment.
METHODS:
We
performed a systematic literature review of all studies of bleomycin
therapy for SCSTs that were referenced in MEDLINE (PubMed), EMBASE, and
Cochrane Central Register of Controlled Trials and published from 1986
to 2014.
RESULTS:
Eight
studies totaling 221 patients were included. Rates of pneumonitis
(7.7%; 95% confidence interval, 4.2-11.2) and mortality (1.8%; 95%
confidence interval, 0.1-3.6) related to bleomycin were significant.
However, these results were very similar to those reported for men who
were treated with bleomycin for a male germ cell tumor, suggesting that
women with
ovarian
SCSTs are not particularly vulnerable to bleomycin lung toxicity. The
main risk factors of bleomycin-induced pneumonitis are
high cumulative
bleomycin dose (>400 U or mg), age older than 40 years, and impaired
renal function. Whether
granulocyte colony-stimulating factor is a risk
factor remains controversial.
CONCLUSIONS:
Bleomycin-induced
pneumonitis frequently occurs in patients with SCSTs and lacks
effective treatment. Prevention lies in limiting cumulative bleomycin
dose, monitoring pulmonary function during treatment, discontinuing
bleomycin at the onset of pulmonary symptoms or if pulmonary function is
impaired, and avoiding bleomycin in older patients.
0 comments :
Post a Comment
Your comments?
Note: Only a member of this blog may post a comment.