Abstract
IntroductionAdjuvant local-regional radiotherapy (LRRT) is routinely recommended for breast cancer patients. It is well known being related to pulmonary side-effects. We studied post-RT radiological changes on X-ray and CT, and correlated the findings with Quality of Life (QoL), common dosimetric factors and co-variates. The results were compared with a previously reported cohort of 137 irradiated women.Methods88 women underwent chest X-ray and CT pre-and 4-5 months after 3-D planned LRRT, minimizing the dose to the ipsilateral lung to V20 < 30%. The lung field was divided into 3 regions and the development of post-RT density changes were graded (0-3). Patients with radiological changes were compared with non-responders. Clinical symptoms were registered and data on patient and treatment related co-variates were gathered prospectively. The ipsilateral lung dosimetric factors V13, V20, V30 and mean dose were calculated and QoL was assessed before and 4 months after RT.ResultsThe use of dose-volume constraints significally reduced moderate-severe radiological changes on chest X-ray compared with our earlier study (Chi square trend test: p < 0.001). Symptomatic pneumonitis was also rare in the present study. No agreement was found between CT and chest X-ray as diagnostic tools for post-RT pneumonitis. V13 correlated independently with radiological changes on CT (logistic regression: p = 0.04; ROC area: 0.7). The Co-variates smoking habits, age, chemotherapy, endocrine or trastuzumab therapy did not influence the outcome on multivariate analysis. QoL changes in physical function, i.e. fatigue, dyspnoea were not detected but there was a trend for a worse recovery after chemotherapy in patients with high V13 (Spearman Rank Correlation: p < 0.05).ConclusionsThe use of dose-volume constraints significantly reduced post-RT radiological changes on chest X-ray in LRRT for BC. The lung changes on CT were also generally limited when we used this strategy and was not always picked up on chest X-ray. Variation in V13 alone was correlated with occurrence of lung changes on CT.
Highlights
Adjuvant local-regional radiotherapy (LRRT) is routinely recommended for breast cancer patients
Quality of Life (QoL) changes in physical function, i.e. fatigue, dyspnoea were not detected but there was a trend for a worse recovery after chemotherapy in patients with high volume receiving ≥ 13 Gy (V13) (Spearman Rank Correlation: p < 0.05)
We found no case of moderate symptomatic radiation pneumonitis (RP) in patients who received doses ≥ 20 Gy (V20) to less than 30% of the ipsilateral lung volume [5]
Summary
Adjuvant local-regional radiotherapy (LRRT) is routinely recommended for breast cancer patients. Postoperative radiotherapy (RT) for breast cancer (BC) plays an important role for reducing the rates of local recurrence and death [1,2,3]. The risk for acute and chronic RT-induced lung morbidity is influenced by total dose, dose per fraction and irradiated lung volume. When a 3-D RT-planning technique is used, it is possible to quantify and limit the amount of individually irradiated lung volume. Clinical data suggest that a total lung dose of more than 20 Gy given with conventional fractionation tissue can occur as early as 6 weeks from the start of RT with symptoms of fever, dyspnoea and cough [15]. Signs of interstitial pulmonary inflammation can be detected on chest radiography (X-ray) in the irradiated lung. A later phase with fibrosis can be detected from 20 weeks and after about 36 weeks stationary fibrosis is obtained [16,17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
