Radiological findings when very small lung volumes are irradiated in breast and chest wall treatment

Radiation Induced Lung Reactions in Breast Cancer Therapy

“…Similar observations were made by Slanina et al [30]. In contrast, more recent studies in breast cancer patients [3,9,14,22] and lung cancer patients [5,18,26] did not confirm the age dependence. While these more recent studies included correction for inhomogeneities in lung density for dose planning, this was not considered in the earlier studies, including the present investigation.…”

“…It is well known from preclinical [11] and clinical studies [17,30,32] that -in contrast to radiologic changes -clinical symptoms of pneumopathy are highly dependent on the lung volume exposed, and hence this difference can be attributed to the smaller irradiated volume in the BCT groups. Corresponding data from the literature range between 0% and 34% [5,16,22,25], with higher incidences associated with a higher number of fields, again indicating the volume effect for symptomatic radiation reactions. However, these data may be confounded by different definitions of the clinical endpoints as well as by variations in the intensity of the examinations.…”

“…In 20/21 of these patients the more sensitive procedures revealed fibrotic changes, and only one patient remained without diagnosis of fibrosis. The higher sensitivity of three-dimensional reconstructive procedures was repeatedly reported [2,5,15,25,27].…”

The Risk of Early and Late Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

“…The existence of an association between smoking and radiation lung injury in breast cancer patients is controversial (5,14,34,35). Johansson et al (35) and Theuws et al (14) found lower incidence of radiation pneumonitis in smoking breast cancer patients (14,35), malignant lymphoma patients (14), and esophagus cancer patients (35) compared with nonsmokers.…”

Lung and cardiac tissue doses in left breast cancer patients treated with single-source breast brachytherapy compared to external beam tangent fields

“…With modern 3D conformal external beam radiation techniques, early and late radiation toxicities are uncommon events (9,10). For low-risk left breast cancer patients, irradiation commonly involves a pair of tangential fields with a very small amount of lung and heart included in the radiation portal (11). Modern 3D conformal radiation planning systems have allowed the radiation oncologist to quantify the volume of critical structures exposed to radiation in order to make treatment decisions.…”