Birgitta Versluijs

35 Pulmonary complications of childhood cancer treatment Recommendations for screening and treatment of pulmonary late effects Long-term follow up, using exposure driven, risk based screening protocols is warran- ted in childhood cancer survivors. Besides thorough history taking and physical exami- nation, PFTs can help in screening for pre-symptomatic lung damage. Implications of subclinical findings are yet unknown, but could have important meaning when the po- pulation ages and pulmonary function shows its physiological decline. The Dutch Children’s Oncology Group-late effects group (SKION LATER) currently recommends screening in all survivors exposed to chest irradiation (including TBI), busulphan, bleomycin, nitrosureas, and pulmonary or thoracic surgery, with lifelong re- gular full medical assessment, and PFTs at least 5 and 10 years after diagnosis. Whenever necessary, (paediatric) respiratory specialists are to be consulted. Yearly influenza im- munization is recommended in case of impaired lung function and strong nonsmoking advice is given (in all survivors). This screening will be of benefit for the individual sur- vivor, as early detection of pulmonary problems will guide future therapy. This will also provide further insight in risk factors for pulmonary late effects and add knowledge by exploring genetic susceptibility, identification of predictive biomarkers and monitoring for late effects of new agents. Increasing awareness of adverse pulmonary outcomes in general practitioners and adult pulmonologists, will help identify patients with early symptoms of pulmonary disease. Future directions for research • The spectrum of pulmonary late effects with longer follow up and ageing of child- hood cancer survivors, with special emphasis on lung cancer, vasculopathy and other degenerative diseases. • Estimation of the precise absorbed radiation dose/volume parameters for the lung and the heart using a novel dosimetry approach in CCS, and correlate this with pul- monary late effects. • The total burden of self-reported persistent cough and other respiratory problems the relation with treatment and the impact on quality of life, daily activities and other organs. This is currently being studied in a nationwide cohort of long-term CCS versus healthy siblings. • Pulmonary effects of new agents used in treatment of childhood cancer. 2