title: A case of metachronous bilateral breast cancer with bilateral radiation pneumonitis after breast-conserving therapy.
abstract: We report a patient with metachronous bilateral breast cancer who has twice developed radiation pneumonitis after breast-conserving therapy for each breast. The patient was a 48-year-old woman, who presented with Stage I right breast cancer. After wide excision of the right breast tumor and dissection of level I axillary lymph nodes, systemic therapy with oral 5-FU and tamoxifen was started. Subsequently, tangential irradiation with a total dose of 50 Gy in 25 fractions was given. Seven months after irradiation, she developed respiratory symptoms and radiation pneumonitis was diagnosed. The symptoms resolved with oral prednisolone. Thirty months after the right breast cancer treatment, Stage I left breast cancer was diagnosed. After wide excision of the left breast tumor and partial removal of the level I axillary lymph nodes, the same oral systemic chemo-hormonal therapy was initiated. Thereafter, tangential irradiation with a total dose of 50 Gy in 25 fractions was given. Four months after irradiation, she developed respiratory symptoms. A chest X-ray showed an area of increased density in the left lung consistent with radiation pneumonitis. The symptoms were mild and they improved spontaneously without medication. Although there is insufficient evidence to justify or withhold whole breast radiation therapy from patients with a history of contralateral breast cancer and radiation pneumonitis, it is essential to discuss the adequacy of whole breast irradiation and the possibility of alternative approaches, such as breast-conserving surgery without irradiation or partial breast irradiation for this rare condition.
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Narabayashi
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Michihide
authors.initials: M
authors.lastname: Mitsumori
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Araki
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Yamauchi
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Sachiko
authors.initials: S
authors.lastname: Kawamura
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Tachiiri
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Natsuo
authors.initials: N
authors.lastname: Oya
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nagata
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hiraoka
authors.affiliation: Kodama Breast Clinic, Kyoto, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Mise
authors.affiliation: Kodama Breast Clinic, Kyoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kodama
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017564:Radiation Pneumonitis / Q000209:etiology*; D013902:Radiography, Thoracic; D013629:Tamoxifen / Q000008:administration & dosage
chemical_list: D013629:Tamoxifen; D005472:Fluorouracil