Bronchiolitis Obliterans Organizing Pneumonia Syndrome Research Articles

Radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome in breast cancer patients is associated with age.

BackgroundRadiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome is a rarely observed phenomenon characterized by infiltration of the lungs outside of the radiation field, differentiating it from radiation pneumonitis (RP).The risk factors for radiation-induced BOOP (RT-BOOP) remain unclear and controversial. We retrospectively analyzed the incidence and risk factors for RT-BOOP associated with radiation therapy (RT) after breast conserving surgery (BCS) and post-mastectomy radiation therapy (PMRT).Methods and materialsWe analyzed 1,176 breast cancer patients treated with RT after BCS or PMRT between March 2005 and September2008 at the cancer institute hospital of the Japanese foundation for cancer research. Chest radiographs were routinely obtained every three to six months for at least 12 months after surgery, as well as when the patients experienced respiratory symptoms or fever.ResultsRT-BOOP syndrome was diagnosed in 16patients (1.4%), including12BCS patients (1.3%) and four PMRT patients (1.8%). An older age (≥52 years old) was significantly associated with the incidence of RT-BOOP syndrome in a univariate analysis (p =0.023). The type of treatment (BCS or PMRT) and irradiated lung volume at 20 Gy (V20) were not significantly associated with the incidence of RT-BOOP syndrome in the entire patient cohort. In the multivariate analysis, age and smoking were the significant factor associated with RT-induced BOOP syndrome (p =0.044 and 0.049, respectively).ConclusionsRT-BOOP syndrome was a rarity, and the incidence for BCT cases was similar to that for PMRT cases. The irradiated lung volume was not significantly associated with RT-BOOP syndrome. An older age can predict the incidence of RT-BOOP syndrome.

Radiation-induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome in Breast Cancer Patients

Radiation-induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome in Breast Cancer Patients

The clinical characteristics and non-steroidal treatment for radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy

Purpose A rare and unique occurrence of radiation-induced pulmonary injury was observed outside the tangential field for early breast cancer treatment. The findings appeared to be idiopathic and were termed radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome. The goal of this study was to report and determine the incidence, analyze the characteristics of the pulmonary lesions on the images and also investigate the treatment methods. Materials and methods A retrospective analysis was conducted of 616 consecutive patients that underwent breast-conserving therapy (BCT) from January 1992 to December 2008. The patients were observed at least one year after radiotherapy for BCT. Radiotherapy was administered by 4 MV photons in all patients. The patients underwent chest X-rays periodically. If the BOOP syndrome was found, chest computed tomography (CT) were conducted to identify the characteristics of the pulmonary lesion outside the radiation field. Results The incidence of the radiation-induced BOOP syndrome was 12 patients (1.9%). Six of them had fever and cough, 6 had no symptoms. The pulmonary lesions were classified into four patterns on chest CT. Progression of the pulmonary lesions observed on chest X-ray were classified into three patterns. BOOP syndrome appeared within 5.6 months after radiotherapy and completely disappeared within 12 months after its onset. Their clinical conditions were not severe and these pulmonary lesions disappeared gradually without use of steroids in our institution. There was no death caused by BOOP syndrome. Conclusions Although the incidence of BOOP syndrome and its associated prognosis are not significant, this clinical condition must be carefully followed using diagnositic imaging in order to not over administer steroids.

Risk factors for radiation pneumonitis caused by whole breast irradiation following breast-conserving surgery

We evaluated risk factors of radiation pneumonitis (RP) after whole breast irradiation following breast-conserving surgery. Four hundred and seventy-two cases underwent whole breast irradiation with tangential field following breast-conserving surgery in our hospital, between January 2005 and April 2007. Of these cases, we performed statistical analyses for 423 breasts of 413 patients, using a pulmonary dose-volume histogram. Patient characteristics, treatment regimens and irradiation methods were included as variables in the analyses on risk factors of RP. As a result, 89 breasts of 84 cases (21%) were diagnosed with RP. The version 3.0 of the NCI Common Terminology Criteria for Adverse Events was used to evaluate the grade of pneumonitis: 77 cases (18.2%) were diagnosed as Grade 1 RP, 10 cases (2.3%) as Grade 2, and 2 cases (0.5%) as Grade 3. Multivariate analysis indicated that the significant risk factors for RP were central lung distance (CLD) (>1.8 cm) and the short axis length of the radiation field. The incidence of radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome significantly correlated only with CLD. The lung volume within the radiation field was shown to be a significant risk factor for RP and radiation-induced BOOP syndrome.

Analysis of Factors Associated With Radiation-Induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome After Breast-Conserving Therapy

To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy. A total of 702 women with breast cancer who received radiotherapy after breast-conserving surgery at seven institutions between July 1995 and December 2006 were analyzed. In all patients, the whole breast was irradiated with two tangential photon beams. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months, (2) general and/or respiratory symptoms lasting for >or=2 weeks, (3) radiographs showing lung infiltration outside the radiation port, and (4) no evidence of a specific cause. Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Eleven patients (68.8%) were administered steroids. The duration of steroid administration ranged from 1 week to 3.7 years (median, 1.1 years). Multivariate analysis revealed that age (>or=50 years; odds ratio [OR] 8.88; 95% confidence interval [CI] 1.16-67.76; p = 0.04) and concurrent endocrine therapy (OR 3.05; 95% CI 1.09-8.54; p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was >or=50 years and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome. Age (>or=50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Physicians should carefully follow patients who received breast-conserving therapy, especially those who are older than 50 years and received concurrent endocrine therapy during radiotherapy.

Analysis of Factors Associated with Radiation-induced Bronchiolitis Obliterans Organizing Pneumonia (BOOP) Syndrome after Breast-conserving Therapy

Purpose/Objective(s)To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy.Materials/MethodsThe criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months; (2) general and/or respiratory symptoms lasting for at least 2 weeks; (3) radiographs showing lung infiltrations outside the radiation port; and (4) no evidence of a specific cause. We retrospectively analyzed 702 women patients with breast cancer who received radiotherapy after breast-conserving surgery at 7 institutions between July 1995 and December 2006 and whose follow-up periods from radiotherapy were more than 12 months. In all patients, the whole breast was irradiated with 2 tangential photon beams. Factors associated with radiation-induced BOOP syndrome were analyzed by logistic regression. Age (<50 or ≥50 years), the side affected, asthma, diabetes, drug allergy, chemotherapy, concurrent chemotherapy, endocrine therapy, concurrent endocrine therapy, radiotherapy method, photon energy (4-6 MV or 10 MV), wedge filter, central lung distance (<3 or ≥3 cm), field length (<20 or ≥20 cm), irradiation to the supraclavicular region, boost to tumor bed, and overall radiotherapy time (<36 or ≥36 days) were evaluated as categorical data.ResultsRadiation-induced BOOP syndrome was seen in 16 patients (2.3%). Multivariate analysis revealed that age (≥50years; p = 0.04) and concurrent endocrine therapy (p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was 50 years and older and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome.ConclusionsAge (≥50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Purpose/Objective(s)To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy. To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy. Materials/MethodsThe criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months; (2) general and/or respiratory symptoms lasting for at least 2 weeks; (3) radiographs showing lung infiltrations outside the radiation port; and (4) no evidence of a specific cause. We retrospectively analyzed 702 women patients with breast cancer who received radiotherapy after breast-conserving surgery at 7 institutions between July 1995 and December 2006 and whose follow-up periods from radiotherapy were more than 12 months. In all patients, the whole breast was irradiated with 2 tangential photon beams. Factors associated with radiation-induced BOOP syndrome were analyzed by logistic regression. Age (<50 or ≥50 years), the side affected, asthma, diabetes, drug allergy, chemotherapy, concurrent chemotherapy, endocrine therapy, concurrent endocrine therapy, radiotherapy method, photon energy (4-6 MV or 10 MV), wedge filter, central lung distance (<3 or ≥3 cm), field length (<20 or ≥20 cm), irradiation to the supraclavicular region, boost to tumor bed, and overall radiotherapy time (<36 or ≥36 days) were evaluated as categorical data. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months; (2) general and/or respiratory symptoms lasting for at least 2 weeks; (3) radiographs showing lung infiltrations outside the radiation port; and (4) no evidence of a specific cause. We retrospectively analyzed 702 women patients with breast cancer who received radiotherapy after breast-conserving surgery at 7 institutions between July 1995 and December 2006 and whose follow-up periods from radiotherapy were more than 12 months. In all patients, the whole breast was irradiated with 2 tangential photon beams. Factors associated with radiation-induced BOOP syndrome were analyzed by logistic regression. Age (<50 or ≥50 years), the side affected, asthma, diabetes, drug allergy, chemotherapy, concurrent chemotherapy, endocrine therapy, concurrent endocrine therapy, radiotherapy method, photon energy (4-6 MV or 10 MV), wedge filter, central lung distance (<3 or ≥3 cm), field length (<20 or ≥20 cm), irradiation to the supraclavicular region, boost to tumor bed, and overall radiotherapy time (<36 or ≥36 days) were evaluated as categorical data. ResultsRadiation-induced BOOP syndrome was seen in 16 patients (2.3%). Multivariate analysis revealed that age (≥50years; p = 0.04) and concurrent endocrine therapy (p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was 50 years and older and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome. Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Multivariate analysis revealed that age (≥50years; p = 0.04) and concurrent endocrine therapy (p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was 50 years and older and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome. ConclusionsAge (≥50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Age (≥50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy.

A Survey of Radiation-Induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome After Breast-Conserving Therapy in Japan

We observed a rare and unique occurrence of radiation-induced pulmonary injury outside the tangential field for early breast cancer treatment. The findings appeared to be idiopathic and were called radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome. We surveyed major hospitals in Japan to review their findings of radiation-induced BOOP, in particular the clinical and pictorial characteristics of the entity. We reviewed surveys completed and returned by 20 institutions. The survey responses were based on a total of 37 cases of BOOP syndrome. We also reviewed X-ray and computed tomography scans provided by these institutions. We discussed the information derived from the questionnaire and analyzed patients' characteristics, methods used in the treatment of BOOP syndrome, and prognosis. The incidence of the radiation-induced BOOP syndrome was about 1.8% (37 of 2,056). We did not find a relationship between the characteristics of patients and the occurrence of radiation-induced BOOP syndrome. The pulmonary findings were classified into four patterns on chest computed tomography scans. Progression of the pulmonary lesions observed on chest X-ray was classified into three patterns. Pneumonitis appeared within 6 months after radiotherapy was completed and disappeared within 6-12 months after its onset. At 5-year follow-up, 2 patients had died, 1 of breast cancer and the other of interstitial pneumonitis, which seemed to be idiopathic and unrelated to the radiation-induced BOOP syndrome. Although the incidence of BOOP syndrome and its associated prognosis are not significant, the patients' clinical condition must be carefully followed.

A Case of Bronchiolitis Obliterans Organizing Pneumonia Syndrome with Preceding Radiation Pneumonitis after Breast-conserving Therapy

Recent case series have demonstrated that bronchiolitis obliterans organizing pneumonia (BOOP) after radiation therapy to the breast is a distinct clinicopathological entity. Most of the investigators speculated that radiation may prime the development of BOOP through an unidentified immunological process; however, none of them showed the relationship between direct radiation injury and BOOP. We report herein a case of a 67-year-old female with BOOP following direct radiation damage confined to the irradiated area after breast-conserving therapy. This is the first case demonstrating that BOOP after breast-conserving therapy arises from direct radiation injury.

Bronchiolitis obliterans organizing pneumonia syndrome in breast-conserving therapy for early breast cancer: Radiation-induced lung toxicity

Purpose: Breast-conserving surgery and postoperative radiotherapy have played important roles in the treatment of early breast cancer. Bronchiolitis obliterans organizing pneumonia (BOOP) syndrome has recently been reported to be one of the complications of adjuvant radiotherapy. The purpose of this study was to determine the incidence of and risk factors for BOOP syndrome in breast cancer patients. Methods and Materials: Between January 1996 and December 1998, 157 patients with breast cancer underwent radiotherapy after breast-conserving surgery. The criteria used for the diagnosis of BOOP syndrome were as follows: 1) radiation therapy to the breast within 12 months, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lung infiltrates outside the radiation port, and 4) no evidence of a specific cause. Results: BOOP syndrome developed in 4 (2.5%) patients, who had fever and nonproductive cough, with patchy infiltrative shadows on chest roentgenograms which emerged between 5 and 6 months after radiotherapy. The symptoms and pulmonary infiltrates were rapidly improved by treatment with prednisone (40 mg/day), which was tapered over 2- to 5-month periods. However, BOOP syndrome relapsed in all cases during the tapering period or after withdrawal of prednisone. The eosinophil and neutrophil counts were increased and the ratios of CD4+ to CD8+ lymphocytes were elevated in bronchoalveolar lavage fluid in all four cases. There were no differences in proportions of patients by age, irradiated breast site, use of tamoxifen and/or chemotherapy, or radiation dose between those with and without BOOP syndrome. Conclusions: BOOP syndrome is considered an intractable form of lung toxicity after radiotherapy to the breast. An immunologic reaction mediated by eosinophils, neutrophils, and lymphocytes may be responsible for the development of this syndrome. Methods of prevention of BOOP syndrome should be established.

Bronchoalveolar lavage in bronchiolitis obliterans organizing pneumonia primed by radiation therapy to the breast

Background: Growing evidence indicates that unilateral lung irradiation for breast cancer may “prime” the development of migratory lung infiltrates with histologic features of bronchiolitis obliterans organizing pneumonia. Objective: Our purpose was to evaluate the cytologic and immunocytologic features of bronchoalveolar lavage in this condition. Methods: We analyzed the profile bronchoalveolar lavage cell differentials and lymphocyte subpopulations of 11 women with bronchiolitis obliterans organizing pneumonia syndrome after radiation therapy for breast cancer in comparison to 9 healthy women. Results: The bronchoalveolar lavage analysis demonstrated a significant increase in the percentage of lymphocytes (36.7% ± 5.4% vs 8.6% ± 1.1%, P = .0002), neutrophils (3.8% ± 1.2% vs 0.6% ± 0.2%, P = .005), eosinophils (2.4% ± 1% vs 0.3% ± 0.1%, P = .01), and mast cells (1.4% ± 0.6% vs 0.1% ± 0.02%, P = .05) with a significant decrease in the percentage of macrophages (56.1% ± 6% vs 90.3% ± 1.4%, P = .0002) in patients with bronchiolitis obliterans organizing pneumonia compared with the control subjects. The percentage of CD3+ cells was significantly increased in patients with bronchiolitis obliterans organizing pneumonia (93.7% ± 1.3% vs 70.9% ± 4%, P = .0004), with a significant decrease in CD4+ cells (32.7% ± 4.7% vs 55.4% ± 2.6%, P = .002) and a significant increase in CD8+ cells (61.2% ± 4.8% vs 37.5% ± 2.9%, P = .003) in comparison to control subjects. The CD4/CD8 ratio was significantly reduced in patients with bronchiolitis obliterans organizing pneumonia compared with control subjects (0.6% ± 0.1% vs 1.5% ± 0.1%, P = .001). Conclusion: These data add to the view that unilateral lung irradiation for breast cancer may “prime” the development of a syndrome quite similar to idiopathic bronchiolitis obliterans organizing pneumonia. (J Allergy Clin Immunol 2000;105:239-44.)

Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. The Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM"O"P)

Reports of bronchiolitis obliterans organizing pneumonia (BOOP) occurring in women after radiation therapy for breast cancer have suggested that radiation to the lung could participate in the development of BOOP. We now describe the clinical, radiographic, functional, and bronchoalveolar lavage characteristics of this syndrome in a series of 15 patients reported to the Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P) in France. All 15 women (60 +/- 6 yr of age) fulfilled the following inclusion criteria: (1) radiation therapy to the breast within 12 mo, (2) general and/or respiratory symptoms lasting for at least 2 wk, (3) lung infiltrates outside the radiation port, and (4) no specific cause. The patients presented with fever, nonproductive cough, mild dyspnea, and peripheral alveolar opacities on chest radiograph with a characteristic migratory pattern. In five patients, BOOP was found at lung pathologic analysis. In all the patients dramatic improvement was obtained with corticosteroids, but relapses occurred in 12 patients while tapering or after stopping corticosteroids. This report demonstrates that a characteristic BOOP syndrome may occur after radiation therapy to the breast, including tangential radiation to the lung, thus suggesting that radiation therapy may prime the development of BOOP.