title: Role of systemic therapy in the development of lung sequelae after conformal radiotherapy in breast cancer patients.
abstract: OBJECTIVE
  To analyze the risk of radiogenic lung damage in breast cancer patients after conformal radiotherapy and different forms of systemic treatment.
  
  
  METHODS
  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.
authors.affiliation: Department of Oncotherapy, University of Szeged, Szeged, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Varga
authors.forename: Adrienn
authors.initials: A
authors.lastname: Cserháti
authors.forename: Gyöngyi
authors.initials: G
authors.lastname: Kelemen
authors.forename: Krisztina
authors.initials: K
authors.lastname: Boda
authors.forename: László
authors.initials: L
authors.lastname: Thurzó
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Kahán
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects / Q000528:radiation effects; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D017564:Radiation Pneumonitis / Q000209:etiology* / Q000473:pathology; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods; D012907:Smoking / Q000009:adverse effects; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D013629:Tamoxifen