Radiation-induced lung injury after concurrent neoadjuvant chemoradiotherapy for locally advanced breast cancer

Abstract

Outcomes for women with locally advanced breast cancer (LABC) remain poor, with a fi ve-year survival of approximately 50%, despite aggressive treatment with a combination of chemotherapy, surgery and radiotherapy, all delivered sequentially [1,2]. Achieving a pathological complete response (pCR) to neoadjuvant systemic therapy (defi ned as no residual disease in the breast or axilla at surgery) is a major favorable prognostic factor [3 – 5]; however, rates of pCR are low: a large meta-analysis demonstrated that 17% of women, on average, achieve a pCR after neoadjuvant treatment [3]. In LABC, concurrent chemoradiotherapy has been associated with higher rates of pCR [4,6]. In an attempt to improve the pCR rate for LABC, a phase II trial was launched to evaluate the effi cacy of a regimen consisting of neoadjuvant docetaxel con-current with locoregional radiotherapy. At the rec-ommendation of the data safety monitoring committee, the trial closed early due to a higher-than-anticipated rate of symptomatic radiation pneumonitis (RP). The goal of this study was to evaluate predictors of symptomatic RP and CT-based radiation-induced lung injury (RILI) in a unique cohort of breast cancer patients treated with concurrent neoadjuvant chemoradiation therapy.