Steroid treatment increases the recurrence of radiation-induced organizing pneumonia after breast-conserving therapy.

Keisuke Otani,Kinji Nishiyama,Yuri Ito,Hideo Inaji,Yoshifumi Kawaguchi

doi:10.1002/cam4.255

Keisuke Otani, Kinji Nishiyama + Show 3 more

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https://doi.org/10.1002/cam4.255

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Abstract

Radiation-induced organizing pneumonia (RIOP) is an important complication of postoperative radiotherapy for breast cancer. Unfortunately, conventional corticosteroid therapy is frequently associated with relapses. The aim of this retrospective study was to evaluate the outcomes of steroid treatment in patients with RIOP. In total, 26 patients diagnosed with RIOP from among 2404 women who received radiotherapy after breast-conserving surgery for breast cancer were included and classified into steroid (n = 7) and nonsteroid (n = 19) groups. Serum, sputum, and bronchoalveolar lavage composition; subjective symptoms (cough, fever, and dyspnea); migratory progression; and RIOP relapse were compared between the groups. Treatment type did not affect the duration of the subjective symptoms, which was 1.6 and 1.7 months for the steroid and nonsteroid groups, respectively. In contrast, RIOP relapse and new pulmonary lesions developed in five patients in the steroid group and only three patients in the nonsteroid group (P = 0.014). By assessing RIOP duration as the time to resolution of symptoms and discontinuation of therapy, the median duration of RIOP was significantly longer in the steroid (17.1 months) than that in the nonsteroid group (2.3 months, P = 0.005), primarily because of frequent relapses. After remission, persistent pulmonary dysfunction did not occur in the nonsteroid group. This single-center retrospective study demonstrates that steroid therapy results in frequent relapses and significantly prolongs RIOP duration. Corticosteroid treatment is considered a critical factor in RIOP recurrence.

Highlights

Early-stage breast cancer is currently treated by breastconserving therapy, involving partial mastectomy followed by postoperative radiotherapy of the remaining breast tissue [1]
Since bronchiolitis obliterans implies nonessential airway obliteration [5], we introduce the term radiation-induced organizing pneumonia (RIOP) to describe bronchiolitis obliterans organizing pneumonia (BOOP) caused by radiotherapy
Our report demonstrated that 89% of the 26 patients were diagnosed with RIOP within 6 months after radiotherapy, which is consistent with the results of previous studies (Table 2)

Summary

Introduction

Early-stage breast cancer is currently treated by breastconserving therapy, involving partial mastectomy followed by postoperative radiotherapy of the remaining breast tissue [1]. The elaborate focusing on the remaining breast tissues with tangential fields affects a small volume of lung tissues. This complication is characterized by fibrotic changes detected by computed tomography (CT). Massive pulmonary infiltrates appear outside the irradiated lung fields [2, 3] in a few patients, and this disorder is classified as radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome [4]. Since bronchiolitis obliterans implies nonessential airway obliteration [5], we introduce the term radiation-induced organizing pneumonia (RIOP) to describe BOOP caused by radiotherapy. Most RIOP patients receive corticosteroid therapy designed to treat severe radiation pneumonitis (RP) in lung cancer. Once severe RP occurs, the patient’s condition often becomes life-threatening despite intensive care and treatment;

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