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Tuğral A, Arıbaş Z, Akyol M, Bakar Y. Understanding changes in pulmonary function and functional status in breast cancer patients after systemic chemotherapy and radiotherapy: a prospective study. BMC Pulm Med 2024; 24:83. [PMID: 38355489 PMCID: PMC10865615 DOI: 10.1186/s12890-024-02890-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Respiratory complications in breast cancer (BC) patients after chemotherapy (CT) and radiotherapy (RT) have been well acquainted and these complications should be investigated to prevent secondary problems and/or improve BC patients' clinical outcomes. Therefore, this study aimed to assess the potential acute effect of systemic chemotherapy and radiotherapy on respiratory function and functional status of patients with breast cancer. METHODS A total of 25 BC patients who were candidates for systemic chemotherapy and radiotherapy were recruited after oncological examination and included in this study. Respiratory function and functional status were assessed with the Pulmonary Function Test (PFT) and the Six-Minute Walk Test (6MWT), respectively. Patients were assessed before CT (c0), after CT (c1), and after RT (r1). RESULTS 25 BC patients were assessed in c0 and c1 while only 15 out of 25 patients (60%) were assessed in r1. The actual values of Forced vital capacity (FVC) (t = 2.338, p =.028), Forced expiratory volume in 1s (FEV1 (t = 2.708, p =.012), and the forced expiratory flow of between 25% and 75% of vital capacity (FEF25-75%) (t = 2.200, p =.038) were found significantly different after systemic CT. Inspiratory (MIP) and expiratory (MEP) muscle strength also did not show a significant change from c0 to c1. A significant effect of the type of surgery was found (Wilks' lambda, F [1, 19] = 6.561, p =.019, ηp2 = 0.25) between c0 and c1 in actual FVC value. The main effect of time was found significant in FVC (F [2, 28] = 4.840, p =.016, ηp2 = 0.25) from c0 to r1. Pairwise comparisons with Bonferroni correction showed that there was a significant difference between c0 and r1 (p =.037). DISCUSSION The present study showed decreased FVC and FEV1 actual values and percent predicted rates from baseline to the completion of treatment. Since the interactional effect of the type of surgery was significant, we suggest that clinical and demographic factors such as age should be considered when interpreting the early changes in PFT. In addition, the significant linear trend of decreasing in some specific outcomes in respiratory function also highlighted the need for continuous monitoring of potential respiratory problems in patients with BC from baseline to the completion of chemotherapy and radiotherapy.
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Affiliation(s)
- Alper Tuğral
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Bakırçay University, Izmir, Turkey.
| | - Zeynep Arıbaş
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Trakya University, Edirne, Turkey
| | - Murat Akyol
- Faculty of Medicine, Department of Medical Oncology, Izmir Bakırçay University, Izmir, Turkey
| | - Yeşim Bakar
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Bakırçay University, Izmir, Turkey
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Verbanck S, Van Parijs H, Schuermans D, Vinh-Hung V, Storme G, Fontaine C, De Ridder M, Verellen D, Vanderhelst E, Hanon S. Lung Restriction in Breast Cancer Patients after Hypofractionated Tomotherapy and Conventional 3D Conformal Radiotherapy: a 10-year Follow-up. Int J Radiat Oncol Biol Phys 2022; 113:561-569. [DOI: 10.1016/j.ijrobp.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
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Prospective Long-Term Follow-Up of Pulmonary Diffusion Capacity Reduction Caused by Dose-Dense Chemotherapy in Patients with Breast Cancer. JOURNAL OF ONCOLOGY 2019; 2019:2584859. [PMID: 31772578 PMCID: PMC6854974 DOI: 10.1155/2019/2584859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
Background Our previous study of pulmonary function in 34 patients with early breast cancer without preexisting lung disease showed that anthracycline- and taxane-based adjuvant dose-dense chemotherapy (DDC) caused a significant 16.4% mean reduction in carbon monoxide diffusing capacity (DLCO). The present study reports the pulmonary and oncological outcomes of these patients on long-term follow-up. Patients and methods The primary endpoint was DLCO measured by the pulmonary function test (PFT) performed at a median of 27 months after DDC (range, 8–97) in 25 patients without disease recurrence. DLCO values were recorded as a percentage of predicted values according to age, height, and hemoglobin level and analyzed relative to baseline pre-DDC DLCO values. The secondary endpoints were symptoms, additional therapies, and cancer outcomes during a median of 11 years' follow-up (range, 4.4–11.4). Results A longitudinal general linear model showed significant effects of time on DLCO and its trend (F(1, 87) = 14.68, p < 0.001 and F(1, 87) = 10.26, p=0.002, respectively). Complementary descriptive analysis showed a significant recovery on the follow-up PFT (75.6% vs. 81.9%, p=0.002), but it was still significantly lower than the baseline DLCO (81.9% vs. 92.0%, p=0.003). Five patients (20%) still showed a >20% relative DLCO reduction from baseline. Patients with dyspnea or fatigue at later clinical follow-up had a significantly lower DLCO value on the follow-up PFT than nonsymptomatic patients (80.5% vs. 92.1%, p=0.02). DLCO recovery was inversely correlated with age (R = −0.39, p=0.05), but no significant correlation was found with the length of time until the follow-up PFT or additional therapies. There was no association of DDC-related DLCO reduction with cancer outcomes. Conclusions The significant reduction in DLCO seen after DDC in patients with potentially curable breast cancer is evident years afterwards, especially in older patients. While most patients partly recover, some will have a lasting symptomatic DLCO impairment.
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Jacobson GM, Siochi RA. Low-Energy Intraoperative Radiation Therapy and Competing Risks of Local Control and Normal Tissue Toxicity. Front Oncol 2017; 7:212. [PMID: 28983466 PMCID: PMC5613079 DOI: 10.3389/fonc.2017.00212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/28/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Geraldine M Jacobson
- Department of Radiation Oncology, WVU Cancer Institute, West Virginia University, Morgantown, WV, United States
| | - Ramon Alfredo Siochi
- Department of Radiation Oncology, WVU Cancer Institute, West Virginia University, Morgantown, WV, United States
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AlSaeed EF, Balaraj FK, Tunio MA. Changes in pulmonary function tests in breast carcinoma patients treated with locoregional post-mastectomy radiotherapy: results of a pilot study. BREAST CANCER (DOVE MEDICAL PRESS) 2017; 9:375-381. [PMID: 28615970 PMCID: PMC5459952 DOI: 10.2147/bctt.s114575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of present pilot study was to evaluate the changes in pulmonary function tests (PFTs) after locoregional post-mastectomy radiotherapy (PMRT) in breast cancer patients. MATERIALS AND METHODS Twenty consecutive patients with histopathologically confirmed breast carcinoma stages T1-T4, N1-N2, who were treated with modified radical mastectomy with neoadjuvant or adjuvant chemotherapy underwent PFTs, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow at 50%, and peak expiratory flow rate, maximum mid expiratory flow (MMEF25-75), maximal oxygen consumption (VO2max), and carbon monoxide diffusing capacity (DLCO) before, at 30 days, and at 90 days after locoregional PMRT. A two-tailed paired Student's t-test was used to compare mean values among the variables between the groups. RESULTS A significant drop in FVC, FEV1, and DLCO was noticed at day 90 after the completion of locoregional PMRT with P-values 0.033, 0.042, and 0.031, respectively, while MMEF25-75 and VO2max were not significantly affected (P-values 0.075 and 0.062, respectively) favoring a restrictive lung injury pattern. However, no patient was found to be symptomatic. CONCLUSION A significant drop in reduction in PFTs occurred at day 90 after the completion of locoregional PMRT. PFTs shall be performed in all breast cancer patients receiving locoregional PMRT for early detection of radiation-induced lung toxicity as all patients in our cohort were found asymptomatic.
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Affiliation(s)
- Eyad Fawzi AlSaeed
- Department of Radiation Oncology, Faculty of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Faisal Khalid Balaraj
- Al Faisal University, Chair of Radiation Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Mutahir A Tunio
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Khan M, Siddiqui SA, Gupta MK, Seam RK, Gupta M. Normal Tissue Complications following Hypofractionated Chest Wall Radiotherapy in Breast Cancer Patients and Their Correlation with Patient, Tumor, and Treatment Characteristics. Indian J Med Paediatr Oncol 2017; 38:121-127. [PMID: 28900318 PMCID: PMC5582547 DOI: 10.4103/ijmpo.ijmpo_80_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Normal tissue complications following chest wall radiotherapy (RT) are inevitable, and the long-term data on hypofractionation are still limited. To quantify the late effects of hypofractionated RT on cardiac, pulmonary, brachial plexus, and regional lymphatics and their correlation with patient, tumor, and treatment characteristics is the main objective of this study. MATERIALS AND METHODS Two hundred and sixteen breast cancer patients following mastectomy were treated with hypofractionated schedules either 40 Gy in 15 fractions or 42.5 Gy in 16 fractions. Common Toxicity Criteria version 3.0 was utilized to quantify the late effects of hypofractionation on cardiac, pulmonary, brachial plexus, and lymphedema at a maximum follow-up of 5 years. RESULTS Median follow-up was 42 months. Median age was 49 years. 14.8% developed ≥Grade (Gr) 2 late cardiac toxicity. 10.2% developed ≥Gr2 late pulmonary toxicity. There were 28.7% patients who developed ≥Gr2 lymphedema. Sixty-seven out of 216 patients had symptomatic brachial plexopathy at 5-year follow-up. Variables found to increase the incidence of these adverse events included smoking, hypertension, diabetes mellitus, body mass index ≥25, extent of axillary dissection, and use of supraclavicular field. CONCLUSION Hypofractionation leads to increased risk of normal tissue complications partly influenced by some patient- and treatment-related factors, but these were manageable and minimally disabling.
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Affiliation(s)
- Mohsin Khan
- Department of Radiotherapy, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Shahid A Siddiqui
- Department of Radiotherapy, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Manoj K Gupta
- Department of Radiotherapy, IGMC, Shimla, Himachal Pradesh, India
| | - Rajeev K Seam
- Department of Radiotherapy, IGMC, Shimla, Himachal Pradesh, India
| | - Manish Gupta
- Department of Radiotherapy, IGMC, Shimla, Himachal Pradesh, India
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O'Donnell DE, Webb KA, Langer D, Elbehairy AF, Neder JA, Dudgeon DJ. Respiratory Factors Contributing to Exercise Intolerance in Breast Cancer Survivors: A Case-Control Study. J Pain Symptom Manage 2016; 52:54-63. [PMID: 26975626 DOI: 10.1016/j.jpainsymman.2016.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/07/2016] [Accepted: 02/13/2016] [Indexed: 11/20/2022]
Abstract
CONTEXT Breast cancer survivors often experience activity-related dyspnea and exercise intolerance, but the underlying mechanisms remain unknown. OBJECTIVES We evaluated physiological contributors to reduced peak oxygen uptake (VO2), with particular attention to the role of respiratory impairment. METHODS We compared symptom assessments, respiratory and peripheral muscle strength, pulmonary function, and ventilatory responses to symptom-limited incremental treadmill exercise in 29 women who had survived breast cancer and 29 age-matched healthy controls. RESULTS Peak VO2 was reduced more than 20%, on average, in the cancer group compared with controls (P < 0.001). Slopes of dyspnea intensity ratings over ventilation or VO2 were >50% greater in the cancer group compared to controls (P < 0.05). Women with breast cancer had lower lung diffusing capacity for carbon monoxide (DLCO), respiratory and limb muscle strength, and ventilatory thresholds during exercise compared with controls (all P < 0.05). During exercise, indices of ventilatory efficiency were similar to controls, but inspiratory capacity (IC) was lower and breathing pattern was more rapid and shallow in the cancer group (P < 0.05). The lower peak VO2 in the cancer group was associated with greater dyspnea intensity, and lower DLCO, IC and ventilatory threshold (all P < 0.05). CONCLUSION Breast cancer survivors had greater peripheral and respiratory muscle weakness, greater reduction of IC, impaired lung diffusion, and evidence of deconditioning compared with controls. Exercise intolerance was multifactorial and correlated well with the combination of these factors as well as with exertional dyspnea. Individualized physiological testing in breast cancer survivors can identify important contributors to exercise intolerance which can be targeted for treatment.
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Affiliation(s)
- Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, Ontario, Canada.
| | - Katherine A Webb
- Respiratory Investigation Unit, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, Ontario, Canada
| | - Daniel Langer
- Respiratory Investigation Unit, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, Ontario, Canada; Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Amany F Elbehairy
- Respiratory Investigation Unit, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, Ontario, Canada; Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, Ontario, Canada
| | - Deborah J Dudgeon
- Palliative Care Medicine, Department of Medicine, Queen's University & Kingston General Hospital, Kingston, Ontario, Canada
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Verbanck S, Hanon S, Schuermans D, Van Parijs H, Vinh-Hung V, Miedema G, Verellen D, Storme G, Fontaine C, Lamote J, De Ridder M, Vincken W. Mild Lung Restriction in Breast Cancer Patients After Hypofractionated and Conventional Radiation Therapy: A 3-Year Follow-Up. Int J Radiat Oncol Biol Phys 2016; 95:937-945. [PMID: 27302510 DOI: 10.1016/j.ijrobp.2016.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/15/2016] [Accepted: 02/01/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the effect of radiation therapy on lung function over the course of 3 years. METHODS AND MATERIALS Evolution of restrictive and obstructive lung function parameters was investigated in 108 breast cancer participants in a randomized, controlled trial comparing conventional radiation therapy (CR) and hypofractionated tomotherapy (TT) (age at inclusion ranging 32-81 years). Spirometry, plethysmography, and hemoglobin-corrected diffusing capacity were assessed at baseline and after 3 months and 1, 2, and 3 years. Natural aging was accounted for by considering all lung function parameters in terms of percent predicted values using the most recent reference values for women aged up to 80 years. RESULTS In the patients with negligible history of respiratory disease or smoking (n=77), the greatest rate of functional decline was observed during the initial 3 months, this acute decrease being more marked in the CR versus the TT arm. During the remainder of the 3-year follow-up period, values (in terms of percent predicted) were maintained (diffusing capacity) or continued to decline at a slower rate (forced vital capacity). However, the average decline of the restrictive lung function parameters over a 3-year period did not exceed 9% predicted in either the TT or the CR arm. Obstructive lung function parameters remained unaffected throughout. Including also the 31 patients with a history of respiratory disease or more than 10 pack-years showed a very similar restrictive pattern. CONCLUSIONS In women with breast cancer, both conventional radiation therapy and hypofractionated tomotherapy induce small but consistent restrictive lung patterns over the course of a 3-year period, irrespective of baseline respiratory status or smoking history. The fastest rate of lung function decline generally occurred in the first 3 months.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium.
| | - Shane Hanon
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
| | - Hilde Van Parijs
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Vincent Vinh-Hung
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Geertje Miedema
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Dirk Verellen
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Guy Storme
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Christel Fontaine
- Department of Senology and Oncologic Surgery, University Hospital UZ Brussel, Brussels, Belgium
| | - Jan Lamote
- Department of Senology and Oncologic Surgery, University Hospital UZ Brussel, Brussels, Belgium
| | - Mark De Ridder
- Department of Radiotherapy, University Hospital UZ Brussel, Brussels, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium
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Jeba J, Isiah R, Subhashini J, Backianathan S, Thangakunam B, Christopher DJ. Radiation Pneumonitis After Conventional Radiotherapy For Breast Cancer: A Prospective Study. J Clin Diagn Res 2015; 9:XC01-XC05. [PMID: 26393189 PMCID: PMC4573021 DOI: 10.7860/jcdr/2015/13969.6211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Loco-regional radiotherapy is an important treatment modality in breast cancer and radiation pneumonitis (RP) is one of the early toxicities. AIM To study the occurrence, correlation of RP with patient and radiotherapy related factors and the effects on pulmonary function following conventional radiotherapy in breast cancer. SETTINGS AND DESIGN Prospective study, from a tertiary hospital in a developing country. MATERIALS AND METHODS Prospective analysis of clinical symptoms, pulmonary function and radiologic changes was done prior to and 12 weeks after adjuvant radiotherapy (n=46). Statistical analysis was done using SPSS version 10 software. RESULTS Radiological and clinical RP was seen in 45.65% (n=21) and 19.56% (n=9) respectively. RP was significantly higher with age >50 years (OR 4.4), chest wall irradiation with electrons, (electrons 83.3% vs cobalt60 32.4%, p=0.02) and supraclavicular field treatment with 6 MV photons (p= 0.011). There was significant relationship between Inferior Lung Distance (ILD) and RP (p=0.013). The fall in Total Lung Capacity (TLC) was significantly more in those with RP (p=0.02). CONCLUSION Clinical RP occurs in almost one-fifth of breast cancer patients treated with conventional radiotherapy. Chest wall irradiation with electrons, supraclavicular field irradiation with 6 MV photons, higher ILD and age >50 years was associated with increased RP. The pulmonary function parameter most affected was TLC. The factors associated with increased RP should be considered when adjuvant radiotherapy is planned to minimize its likelihood and intervene appropriately.
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Affiliation(s)
- Jenifer Jeba
- Associate Professor, Palliative Care Unit, Department of Radiotherapy, Christian Medical College and Hospital, Vellore, India
| | - Rajesh Isiah
- Physician, Department of Radiotherapy, Christian Medical College and Hospital, Vellore, India
| | - J Subhashini
- Professor, Department of Radiotherapy, Christian Medical College and Hospital, Vellore, India
| | - Selvamani Backianathan
- Professor, Department of Radiotherapy, Christian Medical College and Hospital, Vellore, India
| | - Balamugesh Thangakunam
- Professor, Department of Pulmonary Medicine, Christian Medical College and Hospital, Vellore, India
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Jefford M, Mann GB, Nolte L, Russell L, Brennan M. Follow-up of Women with Early Stage Breast Cancer. CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-014-0150-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kim H, Bae H, Lee MY, Cheong KH, Kim KJ, Han T, Kang SK, Park S, Hwang T, Yoon JW, Kim LS. Analysis of predictive factors for lung injury after forward-planned intensity-modulated radiotherapy in whole breast irradiation. J Breast Cancer 2014; 17:69-75. [PMID: 24744800 PMCID: PMC3988345 DOI: 10.4048/jbc.2014.17.1.69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 02/21/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose This study was performed to assess frequency, timings of occurrence, and predictors of radiologic lung damage (RLD) after forward-planned intensity-modulated radiotherapy (FIMRT) for whole breast irradiation. Methods We retrospectively reviewed medical records of 157 breast cancer patients and each of their serial chest computed tomography (CT) taken 4, 10, 16, and 22 months after completion of breast radiotherapy (RT). FIMRT was administered to whole breast only (n=152), or whole breast and supraclavicular regions (n=5). Dosimetric parameters, such as mean lung dose and lung volume receiving more than 10 to 50 Gy (V10-V50), and clinical parameters were analyzed in relation to radiologic lung damage. Results In total, 104 patients (66.2%) developed RLD after whole breast FIMRT. Among the cases of RLD, 84.7% were detected at 4 months, and 15.3% at 10 months after completion of RT. More patients of 47 or younger were found to have RLD at 10 months after RT than patients older than the age (11.7% vs. 2.9%, p=0.01). In univariate and multivariate analyses, age >47 and V40 >7.2% were significant predictors for higher risk of RLD. Conclusion RLD were not infrequently detected in follow-up CT after whole breast FIMRT. More detected cases of RLD among younger patients are believed to have developed at later points after RT than those of older patients. Age and V40 were significant predictors for RLD after whole breast intensity-modulated radiotherapy.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hoonsik Bae
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Me-Yeon Lee
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang-Ho Cheong
- Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyoung Ju Kim
- Department of Radiation Oncology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Taejin Han
- Department of Radiation Oncology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Sei-Kwon Kang
- Department of Radiation Oncology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Soah Park
- Department of Radiation Oncology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Taejin Hwang
- Department of Radiation Oncology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jai-Woong Yoon
- Department of Radiation Oncology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Lee Su Kim
- Division of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
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Santos DED, Rett MT, Mendonça ACR, Bezerra TS, Santana JMD, Silva Júnior WMD. Efeito da radioterapia na função pulmonar e na fadiga de mulheres em tratamento para o câncer de mama. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000100009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo comparou a função pulmonar e a fadiga de mulheres antes e após a radioterapia (RT) adjuvante para tratamento do câncer de mama, e correlacionou a função pulmonar com a dose de radiação e fadiga. Foi conduzido um estudo observacional longitudinal envolvendo 20 mulheres. A função pulmonar foi avaliada pela espirometria (ClementClarke®) e manovacuometria (GlobalMed®, modelo MVD 300), e a fadiga pelo Functional Assessment of Cancer Therapy Fatigue (FACT-F). Todas as avaliações foram realizadas antes da primeira sessão e uma semana após o término da RT adjuvante. Para a análise estatística foram utilizados os testes Wilcoxon Signed Rank Test e correlação de Spearman, adotando-se nível de significância p<0,05. Na espirometria, encontrou-se redução significativa da capacidade vital forçada (23,52%), do volume expiratório forçado no primeiro segundo (26,23%) e do pico de fluxo expiratório (10,12%) (p=0,001). As pressões expiratórias e inspiratórias máximas também diminuíram significativamente (25,45 e 32,92%, respectivamente). Observou-se diminuição significativa do bem-estar físico e do bem-estar funcional, e um aumento significativo da fadiga no FACT-F (p=0,001). Não foram observadas correlações entre as variáveis da função pulmonar com a dose de radiação e fadiga. Em curto prazo, a RT promoveu redução na função pulmonar, mas a mesma permaneceu próxima à normalidade para a amostra estudada. Observou-se aumento significativo da fadiga e diminuição dos escores dos domínios bem-estar físico e funcional.
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Long-term Changes in Pulmonary Function After Incidental Lung Irradiation for Breast Cancer: A Prospective Study With 7-Year Follow-up. Int J Radiat Oncol Biol Phys 2012; 84:e565-70. [DOI: 10.1016/j.ijrobp.2012.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 06/29/2012] [Accepted: 07/04/2012] [Indexed: 11/17/2022]
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Verbanck S, Hanon S, Schuermans D, Van Parijs H, Vinh-Hung V, Miedema G, Verellen D, Storme G, Vanhoeij M, Lamote J, De Ridder M, Vincken W. Small airways function in breast cancer patients before and after radiotherapy. Breast Cancer Res Treat 2012; 135:857-65. [DOI: 10.1007/s10549-012-2201-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 08/07/2012] [Indexed: 11/24/2022]
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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; 82:701-7. [DOI: 10.1016/j.ijrobp.2010.12.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 11/10/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
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Varga Z, Cserháti A, Kelemen G, Boda K, Thurzó L, Kahán Z. Role of systemic therapy in the development of lung sequelae after conformal radiotherapy in breast cancer patients. Int J Radiat Oncol Biol Phys 2011; 80:1109-16. [PMID: 21549513 DOI: 10.1016/j.ijrobp.2010.03.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 03/13/2010] [Accepted: 03/17/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the risk of radiogenic lung damage in breast cancer patients after conformal radiotherapy and different forms of systemic treatment. METHODS AND MATERIALS 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.
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Affiliation(s)
- Zoltán Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
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17
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Schettino RDC, Jotta LMGN, Cassali GD. Função pulmonar em mulheres com câncer de mama submetidas à radioterapia: um estudo piloto. FISIOTERAPIA E PESQUISA 2010. [DOI: 10.1590/s1809-29502010000300011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O câncer de mama é a forma de câncer que mais causa mortes entre mulheres no Brasil. O tratamento consiste em intervenção cirúrgica, quimioterapia, hormonioterapia e radioterapia, esta última responsável por uma significativa diminuição na taxa de recorrência local do câncer, mas que pode afetar a função pulmonar. O objetivo deste estudo foi detectar alterações pulmonares funcionais decorrentes da radioterapia no tratamento do câncer de mama. Participaram do estudo 10 mulheres submetidas a tratamento do câncer de mama, avaliadas quanto à função pulmonar antes e após a radioterapia. Foram mensuradas capacidade inspiratória e capacidade vital forçada, por espirômetro de incentivo, e pressões inspiratória e expiratória máximas, por manovacuômetro. Embora tenha havido redução, em vários casos, dos valores medidos antes e depois da radioterapia, não foi encontrada diferença estatisticamente significativa. Nas pacientes avaliadas, pois, a radioterapia não parece ter prejudicado a função pulmonar.
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18
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Gomide LB, Filho JT, Matheus JPC, Milani JGPO, Carrara HHA, dos Reis FJC. The Long-term Impact of Breast Radiotherapy on Dyspnea and Pulmonary Function. Breast J 2009; 15:560-1. [DOI: 10.1111/j.1524-4741.2009.00786.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Plataniotis GA, Theofanopoulou MA, Sotiriadou K, Kyrgias G. Hypofractionated radiotherapy for breast cancer patients treated by breast-conserving surgery: short-term morbidity and preliminary results. Breast Cancer 2009; 17:42-7. [PMID: 19350358 DOI: 10.1007/s12282-009-0102-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypofractionated adjuvant radiotherapy (RT) in breast cancer patients treated by conservative surgery has been increasingly used in recent years. We present our experience regarding tolerance/acute toxicity of a hypofractionated RT schedule. METHODS AND MATERIALS We report on 339 patients treated for 4 years (March 2003-2007) by 42.5 Gy/16 fractions at the RT Department of Larissa University Hospital. Electron boost of 9-10 Gy/3-4 fractions was given to 104/339 (31%). Axillary/supraclavicular RT was given to the node-positive patients with the same fractionation schedule. Median follow-up time was 24 months. RESULTS RTOG grades 0, 1, 2, 3, and 4 for acute skin toxicity were 9.7, 68.7, 17.5, 4, and 0.3%, respectively. Radiation pneumonitis (resolved promptly by steroids) was suspected/diagnosed in 11/339 (3.2%). A total of 8/11 had been treated by regional lymphatics RT. In the univariate analysis, the following variables were examined as predictive of skin (grade >1) and lung (any grade) reactions: age, chemotherapy, endocrine treatment, RT of regional lymphatics, and boost RT. The only significant correlation was that of radiation pneumonitis and RT of regional lymphatics (Fisher's exact test, P = 0.000). CONCLUSION Our current results are similar to those from other centers, although they need to be evaluated for a longer time. This fractionation seems to be effective with acceptable side effects, while it facilitates the treatment for both patients and RT centers.
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20
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Schmitz KH, Cappola AR, Stricker CT, Sweeney C, Norman SA. The intersection of cancer and aging: establishing the need for breast cancer rehabilitation. Cancer Epidemiol Biomarkers Prev 2007; 16:866-72. [PMID: 17507607 DOI: 10.1158/1055-9965.epi-06-0980] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The increasing success of treatments for common cancers has resulted in growing awareness of the unique health care needs of cancer survivors. Cancer treatments can be toxic and have long-lasting effects on health, potentially accelerating the aging process and producing associated declines in physical function. In this synthesis of the literature, we critically examine the strength of existing evidence that breast cancer diagnosis and treatment are associated with a disproportionate decline in physical function compared with the effects of living without cancer for the same number of years. There is some observational epidemiologic evidence that women treated for breast cancer report greater declines in physical function than their peers. Discerning the factors associated with such declines and their clinical significance remains to be addressed. Physiologic, psychological, and behavioral changes associated with both aging and cancer treatment are reviewed. Parallels are proposed between existing preventive and rehabilitative programs and possibilities for similar interventions aimed at preventing, reversing, or halting declines in physical function in cancer survivors. Finally, a program of research is proposed to evaluate whether there is some subset of breast cancer survivors for whom prevention or rehabilitation of functional status declines is needed, as well as development of targeted, mechanistically driven interventions.
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Affiliation(s)
- Kathryn H Schmitz
- Division of Clinical Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 921 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
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21
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Krengli M, Sacco M, Loi G, Masini L, Ferrante D, Gambaro G, Ronco M, Magnani C, Carriero A. Pulmonary changes after radiotherapy for conservative treatment of breast cancer: a prospective study. Int J Radiat Oncol Biol Phys 2007; 70:1460-7. [PMID: 17931797 DOI: 10.1016/j.ijrobp.2007.08.050] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2007] [Revised: 08/08/2007] [Accepted: 08/23/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE 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 AND MATERIALS 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. CONCLUSION 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.
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Affiliation(s)
- Marco Krengli
- Department of Radiotherapy, University of Piemonte Orientale, Novara, Italy.
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22
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Gomide LB, Matheus JPC, Candido dos Reis FJ. Morbidity after breast cancer treatment and physiotherapeutic performance. Int J Clin Pract 2007; 61:972-82. [PMID: 17362480 DOI: 10.1111/j.1742-1241.2006.01152.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Breast cancer (BC) accounts for >30% of all new cancer patients among women but with increased early detection rates and improved adjuvant therapy, the 5-year survival rate presently reaches >85%. As the number of BC survivors increases, research into the sequelae of the cancer and its treatment on quality of life is a priority. Understanding the potential complications of treatment and developing effective rehabilitation techniques can reduce the impact of such effects on activities of daily life. The aim of this review is to discuss the major sequelae of treatment for BC, and the physiotherapist's role in the prevention and treatment of such complications. Breast cancer treatment can result in pulmonary and upper extremity morbidities that may manifest either early or late. Prevention and treatment of lymphoedema, scar adherence and pulmonary complications can be achieved. Additionally pain reduction and maintenance of range of movement, muscle strength and adequate posture are parts of physiotherapy, which is an important component in the rehabilitation of women with BC.
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Affiliation(s)
- L B Gomide
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil.
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23
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Kahán Z, Csenki M, Varga Z, Szil E, Cserháti A, Balogh A, Gyulai Z, Mándi Y, Boda K, Thurzó L. The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int J Radiat Oncol Biol Phys 2007; 68:673-81. [PMID: 17350177 DOI: 10.1016/j.ijrobp.2006.12.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 11/23/2006] [Accepted: 12/28/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To study the risks of early and late radiogenic lung damage in breast cancer patients after conformal radiotherapy. METHODS AND MATERIALS Radiogenic lung sequelae were assessed prospectively in 119 patients by means of clinical signs, radiologic abnormalities, and the mean density change (MDC) of the irradiated lung on CT. RESULTS Significant positive associations were detected between the development of lung abnormalities 3 months or 1 year after the radiotherapy and the age of the patient, the ipsilateral mean lung dose (MLD), the radiation dose to 25% of the ipsilateral lung (D(25%)) and the volume of the ipsilateral lung receiving 20 Gy (V(20 Gy)). The irradiation of the axillary and supraclavicular lymph nodes favored the development of pneumonitis but not that of fibrosis. No relation was found between the preradiotherapy plasma TGF-beta level and the presence of radiogenic lung damage. At both time points, MDC was strongly related to age. Significant positive associations were demonstrated between the risks of pneumonitis or fibrosis and the age of the patient, MLD, D(25%), and V(20 Gy). A synergistic effect of MLD, D(25%), and V(20 Gy) with age in patients older than 59 years is suggested. CONCLUSION Our analyses indicate that the risks of early and late radiogenic lung sequelae are strongly related to the age of the patient, the volume of the irradiated lung, and the dose to it.
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Affiliation(s)
- Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary.
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24
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Chang ASY, Smedira NG, Chang CL, Benavides MM, Myhre U, Feng J, Blackstone EH, Lytle BW. Cardiac surgery after mediastinal radiation: extent of exposure influences outcome. J Thorac Cardiovasc Surg 2007; 133:404-13. [PMID: 17258573 DOI: 10.1016/j.jtcvs.2006.09.041] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 09/18/2006] [Accepted: 09/29/2006] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Mediastinal radiation for thoracic malignancies uses multiple treatment fields and doses. We investigated whether more extensive radiation exposure is associated with more hospital complications and worse survival after cardiac surgery. METHODS From January 2000 to January 2005, 230 patients underwent cardiac surgery after 3 levels of mediastinal radiation: extensive (Hodgkin disease, thymoma, and testicular cancer; n = 70), variable (eg, non-Hodgkin lymphoma and lung cancer; n = 35); and tangential (breast cancer; n = 125). Hospital complications were recorded prospectively, and time-related survival was assessed by patient follow-up (mean follow-up, 2.2 +/- 1.4 years). RESULTS Patients receiving extensive exposure were youngest (51 vs 64 vs 72 years), with the longest radiation-to-operation interval (25 vs 13 vs 14 years), and had the most diastolic dysfunction, left main stenosis of greater than 70% (21% vs 9% vs 8%), and aortic regurgitation (79% vs 54% vs 50%). Patients receiving extensive and variable exposure had the poorest pulmonary function (percent predicted forced expiratory volume in 1 second, 57% vs 54% vs 67%; percent predicted forced vital capacity, 56% vs 63% vs 66%). All groups received a similar mix of cardiac procedures. Hospital deaths (13% vs 8.6% vs 2.4%) and respiratory complications (24% vs 20% vs 9.6%) were higher after more extensive radiation, and survival was poorer (4-year survival, 64% vs 57% vs 80%) than for patients receiving tangential radiation exposure, and it deviated more from expected matched-population life tables. CONCLUSIONS Among patients undergoing cardiac surgery after thoracic radiation, radiation exposure is heterogeneous, and therefore these patients cannot be managed and assessed as a single uniform cohort. Extensively irradiated patients are more likely to develop radiation heart disease, which increases perioperative morbidity and decreases short- and long-term survival.
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Affiliation(s)
- Albert S Y Chang
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
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25
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Järvenpää R, Holli K, Pitkänen M, Hyödynmaa S, Rajala J, Lahtela SL, Ojala A. Radiological pulmonary findings after breast cancer irradiation: A prospective study. Acta Oncol 2006; 45:16-22. [PMID: 16464791 DOI: 10.1080/02841860500334921] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to evaluate radiation-induced pulmonary abnormalities of breast cancer patients. Altogether 202 consecutive patients receiving postoperative radiotherapy entered the study. Plain chest radiographs taken at entry and 3, 6 and 12 months after radiotherapy were evaluated according to modified Arriagada classification. In addition, pulmonary symptoms were recorded. Supplementary high-resolution computed tomography (HRCT) was employed in a subgroup of patients (n?=?15). Plain radiographs were interpreted by a radiologist, and uncertain findings were re-evaluated by a radiologist together with a radiation oncologist. Grade 2 pneumonitis was the most common abnormality. The proportion of patients yielding a grade 2 finding was 22.5%, 28.1%, and 16.0% at three, six, and twelve months, respectively. There were 2 normal findings in HRCTscans, and 8 in plain radiographs of the same patients. Radiological lung abnormalities are common after radiotherapy, but they are usually reversible, and their significance for the patient's well-being is minor. No correlation between symptoms and lung or pleural reactions was seen.
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Affiliation(s)
- Ritva Järvenpää
- Department of Diagnostic Radiology, Tampere University Hospital, Tampere, Finland.
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26
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Jaén J, Vázquez G, Alonso E, León A, Guerrero R, Almansa JF. Changes in pulmonary function after incidental lung irradiation for breast cancer: A prospective study. Int J Radiat Oncol Biol Phys 2006; 65:1381-8. [PMID: 16757130 DOI: 10.1016/j.ijrobp.2006.03.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 03/07/2006] [Accepted: 03/09/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to analyze changes in pulmonary function after radiation therapy (RT) for breast cancer. METHODS AND MATERIALS A total of 39 consecutive eligible women, who underwent postoperative irradiation for breast cancer, were entered in the study. Spirometry consisting of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), carbon monoxide diffusing capacity (DLCO), and gammagraphic (ventilation and perfusion) pulmonary function tests (PFT) were performed before RT and 6, 12, and 36 months afterwards. Dose-volume and perfusion-weighted parameters were obtained from 3D dose planning: Percentage of lung volume receiving more than a threshold dose (Vi) and between 2 dose levels (V(i-j)). The impact of clinical and dosimetric parameters on PFT changes (Delta PFT) after RT was evaluated by Pearson correlation coefficients and stepwise lineal regression analysis. RESULTS No significant differences on mean PFT basal values (before RT) with respect to age, smoking, or previous chemotherapy (CT) were found. All the PFT decreased at 6 to 12 months. Furthermore FVC, FEV(1), and ventilation recovered almost to their previous values, whereas DLCO and perfusion continued to decrease until 36 months (-3.3% and -6.6%, respectively). Perfusion-weighted and interval-scaled dose-volume parameters (pV(i-j)) showed better correlation with Delta PFT (only Delta perfusion reached statistically significance at 36 months). Multivariate analysis showed a significant relation between pV(10-20) and Delta perfusion at 3 years, with a multiple correlation coefficient of 0.48. There were no significant differences related to age, previous chemotherapy, concurrent tamoxifen and smoking, although a tendency toward more perfusion reduction in older and nonsmoker patients was seen. CONCLUSIONS Changes in FVC, FEV1 and ventilation were reversible, but not the perfusion and DLCO. We have not found a conclusive mathematical predictive model, provided that the best model only explained 48% of the variability. We suggest the use of dose-perfused volume and interval-scaled parameters (i.e., pV(10-20)) for further studies.
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Affiliation(s)
- Javier Jaén
- Department of Radiation Oncology, Puerta del Mar University Hospital, Cádiz, Spain
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Tokatli F, Kaya M, Kocak Z, Ture M, Mert S, Unlu E, Alkaya F, Cakir B. Sequential pulmonary effects of radiotherapy detected by functional and radiological end points in women with breast cancer. Clin Oncol (R Coll Radiol) 2005; 17:39-46. [PMID: 15714928 DOI: 10.1016/j.clon.2004.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To determine the pulmonary effects of locoregional irradiation on clinical and sub-clinical radiographic and functional end points in women with breast cancer, and whether the course of these end points is affected by laterality. MATERIALS AND METHODS Twenty patients (10 irradiated on the left side and 10 irradiated on the right side) were prospectively evaluated for changes in pulmonary function tests, Tc-99m DTPA (diethylenetriamine pentaacetic acid) lung clearance scintigraphy and high-resolution computed tomography (HRCT) at 6, 16 and 52 weeks after radiotherapy. Tc-99m DTPA clearance, expressed as the biological half-time, T(1/2), was computed from the time-activity curves for 10 min for each lung. The irradiated lung volume was calculated for each patient. RESULTS The mean irradiated lung volume was 6.4% +/- 2 (range 3-11%) for the entire population. In the whole study population, two (10%) patients, who were irradiated on the left side, had mild symptomatic radiation pneumonitis in the follow-up period. There was a statistically significant gradual reduction in all pulmonary function test values during the follow-up period. For patients irradiated on the left side, Tc-99m DTPA clearance T(1/2) values were statistically significantly decreased during the follow-up period (P = 0.03), but the decrease was not statistically significant for patients irradiated on the right side (P = 0.62). Tc-99m DTPA clearance T(1/2) values were statistically significantly decreased in the irradiated lung compared with the opposite lung, and no improvement was seen at week 52 after radiotherapy. The number of patients with changes on HRCT scans increased after radiotherapy, reaching a maximum at 16 weeks, when 80% of patients had changes. There was subsequent partial recovery 52 weeks after radiotherapy. CONCLUSION Locoregional irradiation for breast cancer may cause sub-clinical irreversible impairment of radiological and functional pulmonary parameters. The increase in clearance rate of Tc-99m DTPA may be more prominent for patients with left-sided breast cancer.
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Affiliation(s)
- F Tokatli
- Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey.
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Abstract
Radiotherapy plays an essential role in the treatment of patients with breast cancer. The literature in English dealing with radiation therapy in the management of breast cancer published between May 2001 and April 2002 was reviewed. A variety of articles were chosen by the authors to be presented in this review. The areas of particular interest include the role of boost therapy after whole-breast irradiation, the use of intraoperative irradiation after lumpectomy, the management of ductal carcinoma the effect of age on outcome of therapy, and side-effects of irradiation. Space does not allow a comprehensive review of all the published literature, but the articles chosen were thought to be of special interest to those involved in breast cancer management.
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Affiliation(s)
- Deborah A Frassica
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Division of Radiation Oncology, Baltimore, Maryland 21231, USA
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