[Risks factors for pediatric malignant liver tumors]. / Factores de riesgo para los tumores hepáticos malignos pediátricos.

OBJECTIVE: Pediatric Hepatic Malignancies (PHMs) are the result of the interaction between constitutional and environmental risk factors (RFs). We review the evidence on the main RFs associated to PHMs. METHOD: Systematic review of the literature published in the last 25 years on Medline, Embase, Cancerlit, Lilacs and SciElo using the following key words: "etiology/risk factor/epidemiology" and "malignant liver tumors/hepatic cancer" or "hepatoblastoma/hepatocarcionoma". RESULTS: PHMs account for 1 % of all pediatric malignancies. The main types, hepatoblastoma (HB) and hepatocarcionma (HCC) make up 98-99 % of PHM. The main constitutional RFs are: a) Beckwith-Wiedemann (BW) syndrome; b) isolated hemihyperplasia syndrome (IHS); c) adenomatous polyps of the colon; d) hemochromatosis; e) Hereditary Tyrosinemia Type 1; f) a -1-antitrypsin deficiency; g) porphyrias; h) cirrhosis; i) nonalcoholic steatosis; and j) primary sclerosing cholangitis. The main environmental RFs are: a) hepatitis B virus (HBV) and C virus (HCV); b) B1 aflatoxin (B1AF); c) ionizing radiation; d) alcohol; e) hormonal treatments; f) occupational exposure to pesticides, solvents, vinyl chloride and metals; g) smoking; h) arsenic; i) prematury and very low birth weight; and j) trematodes. CONCLUSIONS: The clinical, analytical and ultrasound screening facilitate the early diagnosis of HB in the previously mentioned genetic syndromes, particularly BW and IHS during the first years of life. HBV universal vaccination of newborns provides the biggest opportunity to prevent a substantial proportion of PHMs. Also systematic monitoring of HBV and HCV in blood, hemoderivates, donated organs and drug addicts, are very useful. Other effective measures are: the reduction/elimination of B(1)AF in food, zero alcohol intake during childhood and adolescence as well decreasing prenatal exposure to the tobacco, solvents, pesticides, vinyl chloride, metals, ionizing radiation and hormonal treatments.

[Risk factors for neuroblastoma]. / Factores de riesgo para el neuroblastoma.

INTRODUCTION: NB is the most frequent pediatric cancer arising in the sympathetic nervous system and represents a serious healthcare challenge because: 1) it is the most frequent neoplasm in the first decades of life; 2) it biological behavior is unpredictable (spontaneous regression, maturation to ganglioneuroma, and localized and metastasized variants); and 3) little is known about most of the risk factors involved in its etiopathogenesis. The objective of this study was to disseminate knowledge of constitutional and environmental (physical, chemical, biological and social) risk factors linked to the development of neuroblastoma (NB), with various levels of scientific evidence. To seek collaboration among pediatricians in the research project "Environment and Pediatric Cancer". MATERIAL AND METHODS: We performed a systematic review of the literature published in the previous 25 years on risk factors for NB diagnosed in the first two decades of life, using Medline, the Science Citation Index and Embase. Search profiles were: "neuroblastoma/childhood sympathetic nervous system neoplasms and risk factors/etiology/epidemiology". The most interesting articles and the most relevant references contained therein were selected. RESULTS: With greater or lesser scientific evidence, the following risk factors increase the risk of developing NB: genetic factors; geographic factors; ethnic factors; socioeconomic factors; infectious factors; physical factors; parental occupational exposure; gestational factors; and perinatal and maternal factors. Preventive factors associated with a lower risk of developing NB are breastfeeding and intake of vitamin supplements during pregnancy. CONCLUSIONS: The main barriers to the identification of evidence-based risk factors involved in the development of NB are its complex biology and clinical course, its relative rarity and the difficulty of performing epidemiological studies. Research on constitutional and environmental factors involved in its etiopathogenesis should be stimulated. The best preventive strategy is to recommend breastfeeding for more than 6 months.

Maximal static respiratory pressures in children and adolescents.

This study was designed to establish reference values of maximal static respiratory pressures in children and adolescents in our community, and compare them with previous studies. Participants were recruited from three schools (randomly chosen from those located in the metropolitan area of the city of Valencia) after appropriate consent. None of the participants had a previous history of pulmonary, cardiac, and/or skeletal abnormalities, and all of them had normal spirometry. Forced spirometry (Spirotrac III, Vitalograph) and maximal inspiratory (P(ImaxRV)) and expiratory (P(EmaxTLC)) pressure values (Sibelmed 163) were obtained by the same investigator, following national guidelines (SEPAR 1990).We studied 392 subjects (185 males, 207 females) whose ages ranged from 8-17 years. The reproducibility of measurements was investigated in a subgroup of 88 participants (randomly selected from the total sample, and stratified for age and gender) by means of the intraclass correlation coefficient (P(EmaxTLC), 0.98; P(ImaxRV), 0.95). P(EmaxTLC) and P(ImaxRV) values were significantly different between males and females (P < 0.0001) and were normally distributed. A stepwise, linear multiple regression model was built in each gender group (male/female) for the prediction of P(ImaxRV) and P(EmaxTLC) values. Independent variables (weight, height, and age) and their potential interactions were forced to enter the model in order to maximize the square of the multiple correlation coefficient of the resultant equation. This model turned out to be applicable (homoscedasticity, independence, and normality requirements) for P(ImaxRV) (in males and females) and for P(EmaxTLC) (in males but not in females). Variables included in the model were age and the product of weight and height. Their predictive power ranged between 0.21-0.51. In conclusion, P(ImaxRV) and P(EmaxTLC) values increase with age from 8 until 17 years. In all age groups, values were higher in males than in females. Weight, height, and age are included in the predictive equations for P(ImaxRV) (in males and females) and P(EmaxTLC) (in males). Their predictive value is similar to that reported by other authors and ranges between 0.21-0.51. This model is not suitable for the prediction of P(EmaxTLC) in females; the observed mean and range should be used instead.

[Dietetic factors associated with prostate cancer: protective effects of Mediterranean diet]. / Factores dietéticos asociados al cáncer de próstata. Beneficios de la dieta mediterránea.

OBJECTIVE: To review diet risk factors (RF) implied, more or less evidence-based, in the etiopathology of prostate carcinoma (PC), especially those that characterize the traditional Mediterranean diet (MD). MATERIAL AND METHODS: Literature review of PC related diet RF in MedLine, CancerLit, Science Citation Index y Embase. Search profiles were "Dietetic Factors/Nutritional Factors/Mediterranean Diet/Primary Prevention", and "Prostate Cancer". RESULTS: Diet RF are associated with 35% of cancer mortality and 10-12% of PC mortality. The main diet RF, implied in the development of PC but with a protective effect, which are considered characteristic of MD are: high daily ingestion of vegetarian products (cereals, legumes, dried and fresh fruits, tubers, vegetables..); olive oil as main lipid source; low intake of animal saturated fat, processed red meat, milk and dairy products; regular consumption of small fish; and low alcohol intake (wine with meals). The MD contains many phytoactive compounds (lycopene, lupeol, quercetin, genistein, carnosol, resveratrol, catechins, vitamins..) with PC protective effects. CONCLUSIONS: Diet RF have a role on prostatic carcinogenesis. Further epidemiologic studies with better designs are needed to clarify PC related diet RF. PC risk is reduced in persons on MD compared with those on Western diet. The preventive effect of MD is due to the great number and quality of phytochemicals with antioxidant and antinflammatory properties that contains.

[Non dietetic environmental risk factors in prostate cancer]. / Factores de riesgo ambientales no dietéticos en el cáncer de próstata.

INTRODUCTION: The aim is to update and disclose the main environmental risk factors, excluding dietary factors, involved in the etiopathology of prostate cancer. MATERIALS AND METHOD: Bibliographic review of the last 25 years of non-dietary environmental risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Environmental Risk Factors/Tobacco/Infectious-Inflammatory Factors/Pesticides/Vasectomy/Occupational Exposures/Chemoprevention Agents/Radiation and Prostate Cancer. RESULTS: While some non-dietary environmental risk factors increase the risk of acquiring the disease, others decrease it. Of the former, it is worth mentioning exposal to tobacco smoke, chronic infectious-inflammatory prostatic processes and occupational exposure to cadmium, herbicides and pesticides. The first factors that reduce the risk are the use of chemopreventive drugs (Finasterida, Dutasteride) and exposure to ultraviolet solar radiation. With the current data, a vasectomy does not influence the risk of developing the disease. CONCLUSIONS: The slow process of prostate carcinogenesis is the final result of the interaction of constitutional risk and environmental factors. Non-dietary environmental factors play an important role in the etiopathology of this disease. To appropriately assess the risk factors, extensive case studies that include all the possible variables must be analysed.

[Respiratory function and clinical outcome in infants after premature birth and chronic pulmonary disease]. / Función respiratoria y evolución clínica en lactantes con antecedentes de prematuridad y enfermedad pulmonar crónica.

OBJECTIVE: The purpose of this study was to assess the clinical status and respiratory function of infants with premature birth-related pulmonary sequelae and their correlation. PATIENTS AND METHODS: We studied 23 patients with a mean postnatal age of 32 weeks. All infants were born prematurely and developed respiratory disease with radiological features of bronchopulmonary dysplasia. The neonatal clinical status and evolution were quantified by using clinical scoring systems described previously. Parameters of tidal flow volume curves were assessed by pneumotachography. Static compliance and resistance of the respiratory system were obtained using the single-breath occlusion technique. Results were compared with reference values available in the medical literature. RESULTS: Both the neonatal and evolutive clinical status were given a score of moderate severity. Mean values for weight adjusted compliance and resistance and those for respiratory rate and tidal volume were within the normal range. The mean value for time to peak expiratory flow as a ratio of total expiratory time was under the normal range, showing obstructive airway disease. There was a significant correlation (p < 0.05) between the evolutive clinical score and neonatal clinical score (r = 0.48), compliance (r = 0.50) and respiratory rate (r = 0.67). CONCLUSIONS: Measuring pulmonary function is useful in the follow-up of infants with respiratory disease, providing additional information about the clinical findings, evolution of the illness and subsequent outcome. The development of simple and noninvasive methods explains their increasing application to clinical uses and not exclusively research purposes.

Neuroblastoma IV-S followed by extra-adrenal pheochromocytoma 15 years later.

Common origin of sympathoblasts and pheochromoblasts from the neural crest cells is generally accepted. Neuroblastoma and pheochromocytoma result from an abnormal proliferation of these committed cells. They are included in the group of neuroendocrine neoplasms, formerly named Apudomas. Previous reports of mixed tumours of neuroblastoma and pheochromocytoma, and ganglioneuroma and pheochromocytoma, support this hypothesis. A case of extra-adrenal pheochromocytoma in an adolescent who 15 years before was successfully treated for a stage IV-S neuroblastoma without evidence of primitive tumour is reported. Two hypothesis are formulated: (1) the second neoplasm may have arisen from the unlocated primitive tumour, probably silent evolution could be due to its maturation into ganglioneuroma-pheochromocytoma; (2) taken into account a common origin of both neoplasms, the patient may have a genetic predisposition to develop neuroendocrine tumours. Whatever the mechanism, second neoplasms, as the case reported, late relapses, and late toxic effects may justify long follow-up of neuroblastoma survivors.

Intrathecal chemotherapy-related myeloencephalopathy in a young child with acute lymphoblastic leukemia.

Since the mid-1960s intrathecal chemotherapy (methotrexate [MTX], cytarabine [Ara-C], or both, plus hydrocortisone) has constituted the standard approach to prophylaxis and treatment of central nervous system (CNS) leukemia and lymphoma. Intrathecal chemotherapy-related neurotoxicity has been described in a variable proportion of patients. At least 35 cases of subacute myeloencephalopathy with transient or permanent paraplegia/quadriplegia after intrathecal chemotherapy have been reported. Different factors have been cited: high cumulative MTX dose, meningeal leukemia, cranial irradiation, and preservatives in MTX and Ara-C. A direct toxic effect of the intrathecal chemotherapy seems the most likely mechanism. Early imaging studies are usually normal. We describe a nonfatal case of permanent flaccid quadriplegia after the fourth triple intrathecal chemotherapy in a 6-year-old girl with acute lymphoblastic leukemia and no evidence of meningeal involvement. Six months after intrathecal chemotherapy, CNS magnetic resonance imaging showed severe atrophy of spine, cerebellum, and cerebral hemispheres. The outcome of reported cases is diverse. No treatment has been shown to reverse neurotoxicity. Among the cases reported in the literature, complete recovery of neurologic deficits was observed in 9 patients, partial recovery with variable sequelae in 6, no recovery in 8, and 13 patients died from the initial oncologic disease or neurotoxicity progression.

[The pediatrician and cancer prevention. Dietetic factors and smoking]. / El pediatra y la prevención oncológica. Factores dietéticos y tabaquismo.

Cancer has been associated to well-defined risk factors. Nutritional factors and tobacco are the most important causes of cancer deaths. Prevention should be based on health education. Beikost guidelines should be the early step to implement a healthy diet. American Cancer Society, US Department of Health and Human Services, and the National Academy of Sciences recommendations are analyzed. Recommendations include maintain a desirable body weight, eat a varied diet, include a variety of both vegetable and fruits, eat more high fiber foods, cutdown on total fat intake, limit consumption of alcoholic beverages, salt-cured, smoked and nitrite-cured foods. Suggestions relate to caution with food additives, increase vitamin E intake, proper selenium intake, limit artificial sweeteners, reduce coffee and cholesterol consumption, avoid cooking at high temperatures. Local diets fulfil most of the recommendations. Tobacco consume carries a higher risk of cancer arising from different locations. Pre- and postnatal exposure to tobacco smoke is harmful to health. Prevention requires the combined action of parents, teachers, health professionals, civic associations and governmental institutions.

[Risk factors for Hodgkin's lymphomas]. / Factores de riesgo para los linfomas de Hodgkin.

OBJECTIVE: To divulge the risk factors associated with Hodgkin's lymphoma (HL) in children and adults among pediatricians. METHODS: We performed a literature review of the last 25 years through the Medline, IAR Cancer, and Cancerlit databases. The search profile was "HL risk factors". The most interesting papers, as well as those cited and published more than 25 years prior to the search, were selected. RESULTS: The following risk factors for HL were reported with greater or lesser evidence: a) genetic (variation in the HLA class II region); b) viral infections (Epstein-Barr virus); c) childhood environment and socio-economic status; d) congenital and acquired immunodeficiency; e) medical conditions and f) occupational exposure (the wood industry and its derivatives). CONCLUSIONS: The etiology of most HL is unknown. The most important risk factors are: 1) genetic; 2) Epstein-Barr virus (infectious mononucleosis); 3) congenital and acquired immunodeficiency; 4) occupational exposure (the wood industry).

[Treatment of tobacco use. Pediatric aspects]. / Tratamiento del tabaquismo. Aspectos pediátricos.

OBJECTIVE: To divulge among pediatricians therapeutic modalities against tobacco use. METHODS: Literature review of therapeutic modalities, their efficacy indications, secondary effects and scientific value. Relapse-related factors are analyzed. RESULTS: Tobacco use generates physical (nicotine) and psychological addiction. Treatment strategies should consider both aspects. Different therapies have been applied with unequal results: (1) medical information; (2) pharmacologic treatment: symptomatic drugs and nicotine; (3) therapy psychological including positive reinforcement, aversive techniques and hypnosis; (4) other modalities such as acupuncture, collective and self-obtainment. Relapses have been related to nicotine abstinence syndrome and individual, familiar, professional and social factors. CONCLUSIONS: Pediatricians should engage to tobacco use treatment. Proper medical information will induce patient commitment to stop smoking, aided by nicotine therapy and psychological support. Relapses should be anticipated and adequately approached. Pediatricians have at hand the best available treatment: to prevent adolescents and young adults to start smoking.

[Morbidity, physical growth and psychopathology in marginal populations in suburban areas]. / Morbilidad, crecimiento fisico y psicopatología en poblaciones marginadas en áreas suburbanas.

A comparative study between two distinctive groups of children documenting morbidity, physical growth and psychopathology was completed. 186 children belonging to a marginal and deprived suburban community from Valencia was defined as a experimental group (EG). 100 randomly selected children attending the emergency room of La Fe Children's Hospital was defined as control group (CG). Significant statistical differences were found between the two groups in: type and quality of prenatal care, vaccinations, low stature, depressive symptomatology and bizarre personality and behaviour. No significant statistical differences were found between the two groups in: breast feeding patterns, incidence of respiratory and gastrointestinal illnesses, weight, prematurity, low birth weight, caries and anxiety.

PIP: Aspects of the morbidity, growth, and psychopathology were studied in 186 children living in the barrio of La Coma, a marginal urban zone of Valencia. The children were compared with 100 controls randomly selected at the emergency room of the La Fe Children's Hospital. The barrio of La Coma contained around 5000 low income and disadvantaged residents. 46% of the population was under 16 and 20% were gypsies. Parents or grandparents of the 186 subjects and 100 controls were interviewed in 1991. 2 groups of 55 subjects and 100 controls aged 12- 14 were formed for the study of mental health. 2 questionnaire scales measuring children's anxiety levels were used, the "State Trait Anxiety Inventory of Children" and the "Children's Anxiety Scale". The "Children's Depression" questionnaire scale was used to measure symptoms of depression, and a scale test was used to obtain personality profiles. Both groups were similar in age, sex, and birth place. The control group had a significantly higher average duration of residence in the current location, 14.46 years vs. 3.86 years. The subject children were significantly less likely to have health coverage and more likely to live in female-headed households. The average educational level of the subject children's parents was lower, they were less likely to own their homes, and they had significantly fewer consumer goods such as telephones, automobiles, and televisions. None of the control children lived in households affected by drug addiction, prostitution, delinquency, or alcoholism, but 13.2% of subject children had at least one family member with one of these conditions. Control children were significantly more likely to have received prenatal care and to be completely vaccinated. No significant differences were observed in rates of prematurity or low birth weight, initiation of breastfeeding, dental caries in children over 15 months old, incidence of respiratory or gastrointestinal illness, weight, or anxiety. Control children were significantly taller than subject children. Subject children had significantly higher rates of depression and of personality disorders and overall psychological pathology.

Persistent altered spermatogenesis in long-term childhood cancer survivors.

This study evaluated male gonadal function in long-term survivors of childhood cancer and assessed the suitability of offering sperm analysis to all those patients independently of the diagnosis and treatment received. A total of 43 survivors of acute lymphoblastic leukemia (21), acute myeloid leukemia (1), neuroblastoma (8), ganglioneuroblastoma (1), ganglioneuroma (2), Wilms' tumor (9), and mesoblastic nephroma (1) underwent sperm analysis at a mean age of 20.2 years, after a mean time off treatment of 13.6 years. Eight of the patients (19%) were azoospermic, 2 (5%) were severely oligo-asthenozoospermic, and only 16 (37%) were normozoospermic. A control group of healthy volunteers aged < or = 30 years included no azoospermic subjects, 7% severely oligo-asthenozoospermic, and 67% normozoospermic. Comparisons were also made with patients treated at our Human Reproductive Unit aged < or = 30 years (n = 373) whose percentages for the above parameters were 4, 9, and 42%, respectively. Cumulated cyclophosphamide dose and basal follicle-stimulating hormone (FSH) levels were identified as independent factors associated with azoospermia or severe oligo-asthenozoospermia. Azoospermic and severely oligo-asthenozoospermic survivors had significantly smaller mean testicular volume and higher basal FSH levels than the other survivors, but small testicles (sum of both testicular volume < or = 20 mL) and/or abnormally high basal FSH (> 10 mIU/mL) were present in only half of the azoospermic survivors. Male long-term survivors of childhood cancer constitute a high-risk subpopulation for altered sperm analysis. It seems justified to offer sperm analysis to all long-term survivors.

[A comparative study of the weight-height development of the long-term survivors of acute leukemia and solid tumors]. / Estudio comparativo del desarrollo pondoestatural de los supervivientes a largo plazo de leucemia aguda y tumores sólidos.

OBJECTIVE: Our objectives were to analyze the final height and nutritional status in survivors of childhood cancer, their evolution since diagnosis and to identify neoplasm- and/or therapy-related differences. PATIENTS AND METHODS: A survey of long-term survivors of childhood cancer (acute leukemia, Wilms' tumor, sympathetic nervous system tumors) diagnosed before 15 years of age and between 1971 and 1985 in a single tertiary care center was performed. Final height, target height and body mass index were measured at evaluation. Height and body mass index, at diagnosis and at the end of treatment, was retrieved from their clinical records. All parameters are expressed as standard deviation scores of the mean of the population reference. Survivors were grouped according to diagnosis and type of treatment. Comparisons between groups and within each group were made at the time of diagnosis, at the end of treatment and at the time of evaluation. RESULTS: Sixty-one survivors of acute leukemia and 62 of solid tumors were included (32 Wilms' tumors, 20 neuroblastomas, 4 ganglioneuroblastomas and 6 ganglioneuromas). Eighty survivors had attained final height at the time of evaluation and their target height was available. Fourteen had at least one relapse. The mean height standard deviation score was positive at diagnosis and negative at the time of evaluation in all groups. Mean height loss ranged from -0.84 for the non-irradiated acute leukemia group to -1.34 for the non-irradiated solid tumor group. Adjusted final height for target height showed stature loss only in irradiated groups. Height loss was equivalent in cranially irradiated survivors (-0.32 after 18 Gy, -0.34 after 24-25.5 Gy). The age at menarche correlated negatively with the dose of cranial radiotherapy (r = -0.6, p = 0.002) and positively with stature loss (r = 0.5, p = 0.006). The mean body mass index standard deviation score was negative at diagnosis and positive at the time of evaluation in all groups. Twenty percent of solid tumor survivors and 12.5% of acute leukemia survivors were malnourished at diagnosis. Nutritional status improved in all groups at the time of evaluation. Obesity was more frequent in those who received cranial radiotherapy (14%) or intensified therapy (21%) compared with those non-cranially irradiated (none) or whose therapy was less intense (9%). CONCLUSIONS: Most survivors of childhood cancer attained their target height. Stature loss was related to cranial radiotherapy in acute leukemia survivors and to spinal irradiation in solid tumor survivors. At diagnosis, malnourishment was more frequent in solid tumor patients, while at the time of evaluation obesity was associated with a more intensified therapy.

[Risk factors for lung toxicity in pediatric cancer survivors]. / Factores de riesgo para toxicidad pulmonar en supervivientes de cáncer pediátrico.

OBJECTIVE: Our objectives were to determine the prevalence of alterations in lung function among pediatric cancer survivors with known risk factors and to establish clinical and imaging correlations, as well as to establish follow-up criteria. PATIENTS AND METHODS: Cancer survivors diagnosed at the Pediatric Oncology Unit between 1971 and 1997 who fulfilled at least one of the following criteria were eligible: 1) primary lung or thoracic wall neoplasm; 2) lung metastasis at diagnosis or later, or; 3) irradiation of mediastinum and/or lung fields. Assessment included respiratory symptomatology questionnaire, physical examination, forced spirometry, static lung volumes, maximal static respiratory pressures, single breath CO diffusing capacity, pulse oximetry and imaging studies. RESULTS: Thirty-five (14 females and 21 males) out of 41 survivors were assessed. Mean age at diagnosis, evaluation and follow-up were 9 (1-14), 18 (10-28) and 9 (3-27) years, respectively. The diagnoses included pleuropulmonary blastoma (1), chest wall Ewing's sarcoma (1), Hodgkin's disease (18), nephroblastoma (7), yolk-sac tumor (2), acute leukemia2), non-Hodgkin's lymphoma (1), rhabdomyosarcoma (1), coriocarcinoma of the ovary (1) and osteosarcoma (1). Thirteen patients presented lung metastasis at diagnosis or later. All were administered chemotherapy. Irradiated fields were the mediastinum (dose 20-56 Gy) in 20 cases, the lung (8-30 Gy) in 6 and the spine (24 Gy) in one. Eight underwent thoracotomy. Fourteen percent were dyspneic when walking at the same rate as a person of the same sex and age (grade 2). Twenty percent had a restrictive ventilatory disorder, but none were obstructive. The presence of dyspnea had sensitivity, specificity, positive predictive values and negative predictive value for the diagnosis of restrictive ventilatory disorder of 67%, 96%, 80% and 93%, respectively. Lung irradiation was associated with an increased risk for the development of restrictive disease. Excluding those who received lung irradiation, survivors under 6 years of age at diagnosis obtained lower spirometric values, lung volumes and DLCO values than survivors aged 6 years or older at diagnosis. There were no differences in pulmonary function values between survivors who received mediastinum irradiation and those who did not. The cumulative dose of cyclophosphamide significantly correlated with FVC, FEV1 and FRC. Pulse oximetry values were > or = 95% in all survivors. Maximal static respiratory pressures were within normal limits in all but one survivors whose other pulmonary function results were normal. Thirty-two percent (11 out of 34) had KCO (diffusing capacity adjusted to alveolar volume) values lower than 80% of reference values. Two survivors of nephroblastoma with pulmonary metastasis and who underwent lung irradiation had radiological signs of lung fibrosis. CONCLUSIONS: Pediatric cancer survivors who were administered intensive chemotherapy and/or lung irradiation are eligible for follow-up of lung function. Those diagnosed before 6 years of age and/or with moderate dyspnea are at high risk of having pulmonary restrictive disease. Imaging studies (chest X-ray) have a low sensitivity that prevents their use as a screening method in the follow-up of cancer survivors.