Pulmonary changes after radiotherapy for conservative treatment of breast cancer: a prospective study.
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.
Krengli
Marco
M
Department of Radiotherapy, University of Piemonte Orientale, Novara, Italy. krengli@med.unipmn.it
Sacco
Mariano
M
Loi
Gianfranco
G
Masini
Laura
L
Ferrante
Daniela
D
Gambaro
Giuseppina
G
Ronco
Marco
M
Magnani
Corrado
C
Carriero
Alessandro
A
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