Abnormalities on chest radiographs following radiation therapy for breast cancer

Abstract

The aim of this study was to study pulmonary radiological abnormalities with chest radiography following different radiotherapy (RT) techniques for breast cancer with respect to regions and density, and their association with pulmonary complications and reduction in vital capacity (VC). Chest radiographs were performed 5 months following local or loco-regional RT in 167 breast cancer patients. The radiological abnormalities were analysed with a classification system originally proposed by Arriagada and evaluated according to increasing density (0-3) and affected lung regions (apical-lateral, basal-lateral, central-parahilar). The highest-density grades in each region were added together to form scores ranging from 0 to 9. The patients were monitored for RT-induced pulmonary complications. The VC was measured prior to and 5 months following RT. An independent evaluation of 51 patients was performed by a second radiologist to control the reproducibility of the classification system. Increasing scores were associated with loco-regional RT and pulmonary complications (P < 0.001). The mean reduction of VC for patients scoring 0-3 (-30 ml) vs 4-9 (-161 ml) was not statistically significant (P = 0.10). Scores of 4-9 were more frequently observed in older patients (P < 0.001). The independent evaluations by two radiologists revealed good agreement (P < 0.001) and no systematic inter-observer variation. Radiological abnormalities on chest radiographs, scored according to Arriagada, can be used as an objective end point for RT-induced pulmonary side effects in breast cancer.

Clinical relevance of pulmonary toxicity in adjuvant breast cancer irradiation

“…In contrast to the present report, we found a relationship between target volume/ dosimetric data and clinical symptoms [13], reduction in pulmonary function [14] and radiological changes evaluated with either chest X-ray [15] or conventional CT [16,17]. We found it useful to include regional information on the distribution of the radiological changes, i.e.…”

Radiological pulmonary findings after breast cancer irradiation: A prospective study

“…This discrepancy is explained by the small lung volume irradiated for breast cancer. Kimsey and associates have shown that symptomatic pneumonitis occurs in patients who have more than 10% of the total lung volume irradiated [24]; and a group under Lind reported an association between increasing chest radiograph scores and irradiated lung volumes [19]. In our data symptomatic therapy (corticosteroid) was needed by only two patients (10%) with grade-4 findings in radiographs.…”

“…CT has been used to compare different radiotherapy techniques and the lung injuries they cause [17,18], but not for routine follow-up; plain radiographs have been the routine in follow-up studies. They have also been used in the comparison of lung abnormalities caused by different radiotherapic techniques [19,20].…”

Radiological and functional assessment of radiation-induced pulmonary damage following breast irradiation

“…Lind et al [23] reported a significant different decrease in vital capacity between patients with low and high scores of CT-changes (modified Arriagada classification) 4 months after completion of treatment for 105 breast cancer (BC) patients. However, only a non-significant difference was found after 5 months for 167 BC patients using Arriagada classification on chest radiographs [10].…”