Role of Systemic Therapy in the Development of Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

Abstract

Purpose: To analyze the risk of radiogenic lung damage in breast cancer patients after conformal radiotherapy and different forms of systemic treatment. Methods and Materials: In 328 patients receiving sequential taxane-based chemotherapy, concomitant hormone therapy (tamoxifen or aromatase inhibitors), or no adjuvant systemic therapy, symptomatic and asymptomatic lung sequelae were prospectively evaluated via the detection of visible CT abnormalities, 3 months or 1 year after the completion of the radiotherapy. Results: Significant positive associations were detected between the development of both pneumonitis and fibrosis of Grade 1 and patient age, ipsilateral mean lung dose, volume of the ipsilateral lung receiving 20 Gy, and irradiation of the regional lymph nodes. In multivariate analysis, age and mean lung dose proved to be independent predictors of early (odds ratio [OR] = 1.035, 95% confidence interval [CI] 1.011-1.061 and OR = 1.113, 95% CI 1.049-1.181, respectively) and late (OR = 1.074, 95% CI 1.042-1.107 and OR = 1.207, 95% CI 1.124-1.295, respectively) radiogenic lung damage, whereas the role of systemic therapy was significant in the development of Grade 1 lung fibrosis (p = 0.01). Among the various forms of systemic therapy, tamoxifen increased the risk of late lung sequelae (OR = 2.442, 95% CI 1.120-5.326, p = 0.025). No interaction was demonstrated between the administration of systemic therapy and the other above-mentioned parameters as regards the risk of radiogenic lung damage. Conclusions: Our analyses demonstrate the independent role of concomitant tamoxifen therapy in the development of radiogenic lung fibrosis but do not suggest such an effect for the other modes of systemic treatment. Ó 2011 Elsevier Inc.Radiation lung sequelae, Tamoxifen, Aromatase inhibitors, Taxanes.

Relationship between radiation pneumonitis and organizing pneumonia after radiotherapy for breast cancer

“…The tolerance dose of RP is about 20 Gy; the more V 20Gy increases, the higher the incidence of RP [12,20-22]. …”

Correlation of Conventional and Conformal Plan Parameters for Predicting Radiation Pneumonitis in Patients Treated with Breast Cancer

“…It has been previously reported that radiation-induced lung sequelae affect as many as 9% of patients with breast cancer being treated with RT [24]. However, using computer-based radiation treatment planning systems dramatically decreased the incidence of these lung sequelae [25,26]. …”

Analysis of Predictive Factors for Lung Injury after Forward-Planned Intensity-Modulated Radiotherapy in Whole Breast Irradiation

“…In the previous studies of conventional breast RT, the incidence of RLD was reported to be in the range of 37.0% to 100.0% by chest CT assessment [2,3,7,8,9]. Number of patients, target of RT (remnant breast vs. chest wall), fields of irradiation (local only vs. locoregional), and timing of follow-up chest CT were different in the studies.…”

“…Nonetheless, radiation can cause injury to organs surrounding breast, mainly to ipsilateral lung. Symptomatic or radiographic lung injury after conventional breast RT develops not infrequently with the incidence ranging between 5.5% and 100% according to previous reports [2,3,4,5,6,7,8,9]. …”