title: Pulmonary changes after radiotherapy for conservative treatment of breast cancer: a prospective study.
abstract: OBJECTIVE
  Radiotherapy (RT) after conservative surgery for breast cancer involves part of the pulmonary parenchyma with a potential detrimental effect of reducing the normal functional reserve. Such an effect deserves to be studied in depth, considering the given long life expectancy of these women. We prospectively analyzed high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) with correlation with dosimetric data from RT.
  
  
  METHODS
  Lung HRCT and PFTs were performed in 41 women who had undergone conservative surgery for breast cancer before and 3 and 9 months after postoperative RT. The PFTs included forced vital capacity, forced expiratory volume in 1 s, total lung capacity, maximal expiratory flow at 50% and 25% of vital capacity, and the diffusion capacity of carbon monoxide. HRCT was matched with the RT treatment plan images to analyze the dosimetric correlation.
  
  
  RESULTS
  At 3 months after RT, the lung alterations were classified at HRCT as follows: 46.3% were Grade 1, 24.4% Grade 2, and 7.3% Grade 3, and at 9 months, 58.5% were Grade 1, 19.5% Grade 2, and 0% Grade 3. The PFTs showed a significant decrease at 3 months, with only partial recovery at 9 months. Chemotherapy, but not hormonal therapy, was associated with PFT changes. The grade of fibrosis increased with increasing lung volume treated to a dose > or = 25 Gy.
  
  
  CONCLUSIONS
  Lung changes, mainly related to damage to the alveolar-capillary barrier and smallest airway ramifications, were observed at 3 months, with only partial recovery at 9 months after RT. Minimizing the lung volume receiving > or = 25 Gy could reduce pulmonary toxicity.
authors.affiliation: Department of Radiotherapy, University of Piemonte Orientale, Novara, Italy. krengli@med.unipmn.it
authors.forename: Marco
authors.initials: M
authors.lastname: Krengli
authors.forename: Mariano
authors.initials: M
authors.lastname: Sacco
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Loi
authors.forename: Laura
authors.initials: L
authors.lastname: Masini
authors.forename: Daniela
authors.initials: D
authors.lastname: Ferrante
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Gambaro
authors.forename: Marco
authors.initials: M
authors.lastname: Ronco
authors.forename: Corrado
authors.initials: C
authors.lastname: Magnani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Carriero
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology / Q000528:radiation effects*; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D017564:Radiation Pneumonitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D011879:Radiotherapy Dosage; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed / Q000379:methods