Influence of Radiation Therapy on Lung Tissue in Breast Cancer Patients: CT-assessed density changes 4 years after completion of radiotherapy

Svane, Gunilla; Rotstein, Samuel; Lax, Ingmar

doi:10.3109/02841869509127195

Cited by 18 publications

(9 citation statements)

References 10 publications

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“…In fact, we also had three patients, without prior inflammatory abnormalities, who developed de novo fibrotic changes 1 year after radiotherapy. Our observation is in agreement with the theory that early and late radiogenic lung damage may develop independently (12,13). It is a widely accepted practice to evaluate radiation fibrosis at 12 months (as a minimum time interval) after the irradiation (7,12,30).…”

Section: Discussionsupporting

confidence: 91%

“…The reported incidence of radiation-induced lung injury in breast cancer in prospective studies varies between 4.5% and 63% (3)(4)(5)(6)(7)(8) and in retrospective studies between 0.9% and 30% (9 -11). Early radiation-induced symptoms arise within 6 months after the completion of radiotherapy and may later progress to a chronic fibrotic status (12,13). In older age, the irradiation of a larger lung volume and a higher mean lung dose (MLD) have been found to be risk factors for the occurrence of radiogenic lung damage (11,14).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Risk of Early and Late Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

Kahán

Csenki

Varga

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

118

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The Risk of Early and Late Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

Kahán

Csenki

Varga

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

118

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“…Shapiro et al reported a trend towards lower diffusing capacity of carbon monoxide in Hodgkin's disease patients 3 to 9 months after mantle field radiotherapy (17). Svane et al studied CT-density changes in 22 breast cancer patients before 3 months, 9 months, and 4 years after radiotherapy (18). The greatest changes were seen 3 months after radiotherapy.…”

Section: Time Of Onset Of Lung Changes After Radiotherapymentioning

confidence: 99%

Time Course of Radiological Lung Density Changes After Postmastectomy Radiotherapy

Skoczylas

Bentzen²,

Overgaard³

et al. 2000

Acta Oncologica

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The purpose of this study was to quantify the time course of radiological lung changes in patients after postmastectomy radiotherapy assessed from routine follow-up chest x-rays. Radiological density changes in the apex of the irradiated lung were quantified by a recent lung densitometry assay. Lung changes were expressed as the so-called Relative change in Equivalent Absorber Thickness (REAT). The clinical series comprised 329 patients treated with postmastectomy radiotherapy between 1978 and 1982. Of these patients 100 were treated with chemotherapy (CTX or CMF) and 41 were given tamoxifen as an additional adjuvant treatment; 290 patients (88.2%) had pretreatment x-rays and at least one x-ray after completion of radiotherapy and these were included in the study. A total of 2,209 chest x-rays was taken during follow-up, and among these 1921 x-rays (86.9%) were judged to be assessable. Late changes were defined as changes occurring more than a year after radiotherapy. A total of 280 patients had at least one chest x-ray taken more than one year after radiotherapy and these were evaluable with respect to late changes. There were 1,390 follow-up x-rays in these patients and 207 patients (73.9%) had three or more follow-up x-rays. Linear regression of REAT vs. observation time was used to identify three patterns of time changes: progressive, regressive, and stable. The results were as follows. Two phases of lung changes were observed. The early phase peaks around 6 months and the density changes may subsequently resolve, completely or in part. In most cases (173 patients or 84%), the lung density changes reached a stable level 12 months after irradiation. Yet, in 16 patients (7.7%) the lung changes progressed for five or more years. Regression of the density changes was seen in 18 patients (8.7%), and in some cases there were signs that this apparent regression was caused by contraction of the fibrotic tissue. We conclude that two phases of lung response can be distinguished and can be graded according to severity using this assay. Early lung changes reach a maximum around 6 months after RT. Late reactions reach a plateau in most patients after one year, but progress in some cases for five or more years.

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“…Nonetheless, radiotherapy might cause long-term toxicity, such as radiation-induced pneumonitis and fibrosis of the lung. Early radiation-induced symptoms arise within 6 months after the completion of radiotherapy and may later progress to a chronic fibrotic status (5,6). The incidence of radiationinduced lung injury in breast cancer in different prospective studies varies between 4.5% and 63% (7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Role of Systemic Therapy in the Development of Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

Varga¹,

Cserháti²,

Kelemen³

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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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. Ó 2011 Elsevier Inc.Radiation lung sequelae, Tamoxifen, Aromatase inhibitors, Taxanes.

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Influence of Radiation Therapy on Lung Tissue in Breast Cancer Patients: CT-assessed density changes 4 years after completion of radiotherapy

Cited by 18 publications

References 10 publications

The Risk of Early and Late Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

The Risk of Early and Late Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

Time Course of Radiological Lung Density Changes After Postmastectomy Radiotherapy

Role of Systemic Therapy in the Development of Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

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