Skip to main content Accessibility help
×
×
Home

Radiation pneumonitis and pulmonary function with lung dose–volume constraints in breast cancer irradiation

  • U. Blom Goldman (a1) (a2), M. Anderson (a3), B. Wennberg (a4) and P. Lind (a2) (a5)
Abstract
Purpose

We studied symptomatic radiation pneumonitis (RP) and changes in pulmonary function tests (PFTs) after loco-regional radiotherapy (LRRT) with V20 lung constraints in breast cancer (BC).

Patients and methods

Sixty-four women underwent PFTs before and 5 months after 3D planned LRRT for BC. The incidentally irradiated ipsilateral lung V20 was minimised to <30%. Patients were monitored for symptoms of RP 1, 4 and 7 months after radiotherapy (RT) and data on covariates were collected prospectively. The outcome was compared with previous treatment series.

Results

Pneumonitis was less frequent with the applied constraint, that is, four mild and one moderate case, than in our previous report (p < 0·001). In multivariate analyses, neither dosimetric data nor covariates appeared to influence mean changes in vital capacity [−0·11L, standard error of the mean (SEM) 0·03] or diffusing capacity of the lung for carbon monoxide (DLCO) (−0·20 mmol/kPa/min, SEM 0·01), except for pre-RT chemotherapy, which diminished the change in DLCO 5 months post-RT.

Conclusions

The used constraint and 3D planning lowered the rate of RP and short-term changes in PFTs compared with our previous treatment series. Pre-RT chemotherapy affects DLCO baseline levels. Rates of side effects should be continuously studied when new target definitions or therapies are introduced in LRRT of BC.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Radiation pneumonitis and pulmonary function with lung dose–volume constraints in breast cancer irradiation
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Radiation pneumonitis and pulmonary function with lung dose–volume constraints in breast cancer irradiation
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Radiation pneumonitis and pulmonary function with lung dose–volume constraints in breast cancer irradiation
      Available formats
      ×
Copyright
The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence .
Corresponding author
Correspondence to: U. Blom Goldman, Onkmott Södersjukhuset, 118 83 Stockholm, Sweden. Tel: 0046-8-6164456. Fax 004686164422. E-mail: Ulla.Blom-Goldman@karolinska.se
References
Hide All
1.Darby, S, McGale, P, Correa, Cet al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta- analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011; 378 (9804): 17071716.
2.Clarke, M, Collins, R, Darby, Set al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366 (9503): 20872106.
3.Overgaard, M, Bentzen, S M, Christensen, J J, Madsen, E H. The value of the NSD formula in equation of acute and late radiation complications in normal tissue following 2 and 5 fractions per week in breast cancer patients treated with postmastectomy irradiation. Radiother Oncol 1987; 9 (1): 111.
4.Rothwell, R I, Kelly, S A, Joslin, C A. Radiation pneumonitis in patients treated for breast cancer. Radiother Oncol 1985; 4 (1): 914.
5.Marks, L B, Yu, X, Vujaskovic, Z, Small, W Jr, Folz, R, Anscher, MS. Radiation-induced lung injury. Semin Radiat Oncol 2003; 13 (3): 333345.
6.Kahan, Z, Csenki, M, Varga, Zet al. The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int J Radiat Oncol Biol Phys 2007; 68 (3): 673681.
7.Hermann, T S J, Molls, M. Radiation Pneumopathy. Experimental and clinical data. In: Dunst J, Sauer R H (eds). Late Sequelae in Oncology. Berlin, Heidelberg, New York, 1995: 135140.
8.Lind, P A, Wennberg, B, Gagliardi, G, Fornander, T. Pulmonary complications following different radiotherapy techniques for breast cancer, and the association to irradiated lung volume and dose. Breast Cancer Res Treat 2001; 68 (3): 199210.
9.Marks, L B, Yorke, E D, Jackson, Aet al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 2010; 76 (suppl 3): S10S19.
10.Bentzen, S M, Skoczylas, J Z, Overgaard, M, Overgaard, J. Radiotherapy-related lung fibrosis enhanced by tamoxifen. J Natl Cancer Inst 1996; 88 (13): 918922.
11.Dorr, W, Bertmann, S, Herrmann, T. Radiation induced lung reactions in breast cancer therapy. Modulating factors and consequential effects. Strahlenther Onkol 2005; 181 (9): 567573.
12.Lind, P A, Bylund, H, Wennberg, B, Svensson, C, Svane, G. Abnormalities on chest radiographs following radiation therapy for breast cancer. Eur Radiol 2000; 10 (3): 484489.
13.West, C M, Elliott, R M, Burnet, N G. The genomics revolution and radiotherapy. Clin Oncol (R Coll Radiol) 2007; 19 (6): 470480.
14.Johansson, S, Bjermer, L, Franzen, L, Henriksson, R. Effects of ongoing smoking on the development of radiation-induced pneumonitis in breast cancer and oesophagus cancer patients. Radiother Oncol 1998; 49 (1): 4147.
15.Vogelius, I R, Bentzen, S M. A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis. Acta Oncol 2012; 51 (8): 975983.
16.Lind, P A, Rosfors, S, Wennberg, B, Glas, U, Bevegard, S, Fornander, T. Pulmonary function following adjuvant chemotherapy and radiotherapy for breast cancer and the issue of three-dimensional treatment planning. Radiother Oncol 1998; 49 (3): 245254.
17.Lehne, G, Lote, K. Pulmonary toxicity of cytotoxic and immunosuppressive agents. A review. Acta Oncol 1990; 29 (2): 113124.
18.Taghian, A G, Assaad, S I, Niemierko, A, Floyd, S R, Powell, S N. Is a reduction in radiation lung volume and dose necessary with paclitaxel chemotherapy for node-positive breast cancer? Int J Radiat Oncol Biol Phys 2005; 62 (2): 386391.
19.Theuws, J C, Kwa, S L, Wagenaar, A Cet al. Prediction of overall pulmonary function loss in relation to the 3-D dose distribution for patients with breast cancer and malignant lymphoma. Radiother Oncol 1998; 49 (3): 233243.
20.Azria, D, Belkacemi, Y, Romieu, Get al. Concurrent or sequential adjuvant letrozole and radiotherapy after conservative surgery for early-stage breast cancer (CO-HO-RT): a phase 2 randomised trial. Lancet Oncol 2010; 11 (3): 258265.
21.Halyard, M Y, Pisansky, T M, Dueck, A Cet al. Radiotherapy and adjuvant trastuzumab in operable breast cancer: tolerability and adverse event data from the NCCTG Phase III Trial N9831. J Clin Oncol 2009; 27 (16): 26382644.
22.Belkacemi, Y, Gligorov, J, Ozsahin, Met al. Concurrent trastuzumab with adjuvant radiotherapy in HER2-positive breast cancer patients: acute toxicity analyses from the French multicentric study. Ann Oncol 2008; 19 (6): 11101116.
23. Breast cancer atlas for radiation therapy planning: consensus definitions. 2011. http://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx. Accessed on 27th October 2011.
24.Fontanilla, H P, Woodward, W A, Lindberg, M E, Kanke, J E. Current clinical coverage of Radiation Therapy Oncology Group-defined target volumes for postmastectomy radation therapy. Pract Radiat Oncol 2012; 2 (3): 201209.
25.Erven, K, Weltens, C, Nackaerts, K, Fieuws, S, Decramer, M, Lievens, Y. Changes in pulmonary function up to 10 years after locoregional breast irradiation. Int J Radiat Oncol Biol Phys 2012; 82 (2): 701707.
26.Prochazka, M, Granath, F, Ekbom, A, Shields, P G, Hall, P. Lung cancer risks in women with previous breast cancer. Eur J Cancer 2002; 38 (11): 15201525.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of Radiotherapy in Practice
  • ISSN: 1460-3969
  • EISSN: 1467-1131
  • URL: /core/journals/journal-of-radiotherapy-in-practice
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed