Bronchiolitis Obliterans Organizing Pneumonia Syndrome Primed by Radiation Therapy to the Breast

Abstract

Reports of bronchiolitis obliterans organizing pneumonia (BOOP) occurring in women after radiation therapy for breast cancer have suggested that radiation to the lung could participate in the development of BOOP. We now describe the clinical, radiographic, functional, and bronchoalveolar lavage characteristics of this syndrome in a series of 15 patients reported to the Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P) in France. All 15 women (60 +/- 6 yr of age) fulfilled the following inclusion criteria: (1) radiation therapy to the breast within 12 mo, (2) general and/or respiratory symptoms lasting for at least 2 wk, (3) lung infiltrates outside the radiation port, and (4) no specific cause. The patients presented with fever, nonproductive cough, mild dyspnea, and peripheral alveolar opacities on chest radiograph with a characteristic migratory pattern. In five patients, BOOP was found at lung pathologic analysis. In all the patients dramatic improvement was obtained with corticosteroids, but relapses occurred in 12 patients while tapering or after stopping corticosteroids. This report demonstrates that a characteristic BOOP syndrome may occur after radiation therapy to the breast, including tangential radiation to the lung, thus suggesting that radiation therapy may prime the development of BOOP.

Cryptogenic organising pneumonia

“…A peculiar iatrogenic organising pneumonia is one that is ''primed'' by radiation therapy to the breast (tangential field radiotherapy) [109,[290][291][292][293][294][295][296][297][298][299][300]. It closely resembles COP and clearly differs from radiation pneumonitis, especially because it may involve nonirradiated areas of the lung and possibly be migratory.…”

“…Organising pneumonia primed by radiation therapy had an incidence of 2.5% in a series of 157 patients with breast cancer who underwent radiotherapy after breast-conservative surgery [292], and a 2.4% incidence in another series of 206 patients [300]. It usually develops within 9-16 months after radiation therapy [291,296,301], with the mean age of affected patients being ,60 yrs. As in COP, the patients present with fever, nonproductive cough, mild dyspnoea and peripheral alveolar opacities on chest imaging with a pattern of consolidation and further ground-glass opacities.…”

“…In BAL, a ''mixed pattern'' is present at differential cell count with a marked increase in lymphocytes (,40%), and a mild increase in neutrophils (,4-10%) and eosinophils (,3%). Mast cells are often present (,1-2%) [291,293] and the CD4/CD8 ratio of lymphocytes is decreased [293].…”

Chronic eosinophilic pneumonia after radiation therapy for breast cancer

“…This study reports five cases of females who presented with chronic eosinophilic pneumonia following RT for breast cancer, suggesting that radiation to the lung may promote the development of chronic eosinophilic pneumonia similar to that described for organising pneumonia [2]. All patients had a history of asthma and/or atopic manifestations.…”

“…The authors have previously described the occurrence of bronchiolitis obliterans organising pneumonia as a complication of RT for breast cancer [1,2], a disorder defined by the characteristic presence of granulation tissue within the lumen of distal pulmonary airspaces, with nonspecific clinical manifestations including fever, nonproductive cough, mild dyspnoea, weight loss, and multiple patchy alveolar opacities on chest radiograph.…”