In this study we investigated bleomycin-induced pulmonary toxicity in patients 
with germ-cell tumour by means of technetium-99m diethylene triamine 
penta-acetic acid aerosol scintigraphy. Twenty untreated patients who had no 
clinical or radiological evidence of pulmonary disease received four courses of 
etoposide, cisplatin and bleomycin chemotherapy. Aerosol lung scintigraphy and 
pulmonary function tests were performed in all patients before bleomycin 
treatment and after administration of 180 and 360 mg bleomycin. On the basis of 
the scintigrams the percentage decline in activity per minute (Kep) was 
evaluated, which represented an accurate parameter of lung membrane 
permeability. Pretreatment Kep values (0.891 +/- 0.286) were significantly lower 
than those obtained following 180 and 360 mg bleomycin treatment (1.176 +/- 
0.336 and 1.389 +/- 0.477, respectively; P < 0.0005). The Kep values obtained 
with 180 and 360 mg bleomycin treatments were also significantly different (P < 
0.005). In contrast, no significant change was observed in the results of 
pulmonary function tests. Our results demonstrate that evaluation of the 
pulmonary clearance of 99mTc-DTPA represents a useful means of monitoring the 
functional status of the lung epithelial membrane during bleomycin treatment. 
Further prospective studies are needed to assess the relationship between 
increase in permeability and development of lung toxicity in order to decide 
which patients should discontinue bleomycin therapy.