Post-Breast Cancer Radiotherapy Bronchiolitis Obliterans Organizing Pneumonia

Abstract

BACKGROUND: Radiotherapy for breast cancer has been implicated in the development of bronchiolitis obliterans organizing pneumonia (BOOP). Patients may be asymptomatic or may have pulmonary and constitutional symptoms that are moderate or severe. Postradiotherapy BOOP usually develops during the 12 months after completion of radiotherapy and is characterized by ground-glass opacities in the radiation-exposed lung and frequently in the non-irradiated lung. METHODS: An updated literature search and review was performed to update the systematic review we conducted in 2014. Ten new publications were identified: 2 Japanese epidemiological studies, 1 Japanese case series study, 6 case reports, and 1 review article. RESULTS: The incidence of postradiotherapy BOOP was 1.4% in both Japanese epidemiological studies. Risk factors included increasing age, cigarette smoking, and increasing central lung distance. The case reports included 7 women who had breast cancer postradiation BOOP and 1 woman who had an ataxia telangiectasia mutated (ATM) gene mutation, which may increase radiation sensitivity. CONCLUSION: Postradiotherapy BOOP in women with breast cancer occurs at a rate of 1.0-3.0% and may occur in women with immune system dysfunction and genetic mutations.

Cryptogenic and Secondary Organizing Pneumonia: Clinical Presentation, Radiological and Laboratory Findings, Treatment, and Prognosis in 56 Cases

“…Researchers thought that smoking could be protective against COP development in women [9]. OP is characterized by non-specific symptoms, such as flulike illness [10][11][12][13]. Most of our patients had flu-like symptoms.…”

Relationship Between Radiation Pneumonitis Following Definitive Radiotherapy for Non-small Cell Lung Cancer and Isodose Line

“…The presence of interstitial pneumonitis on CT images, serum surfactant protein D (SP-D) and serum Krebs von den Lungen-6 (KL-6) are also considered risk factors for radiation pneumonitis (23,24). An increasing central lung distance and MLD are considered to be risk factors for the development of radiation pneumonitis in postoperative irradiation of breast cancer (25,26). For definitive radiotherapy for esophageal cancer, V20, MLD and in vivo 35: 3441-3448 (2021) 3444 PTV volume are considered risk factors for the development of radiation pneumonitis (27).…”

Recovery From Bicalutamide-Associated Pneumonitis in a Patient With ATM-Deficient Prostate Cancer

“…19 It is not clear whether the germline heterozygous ATM mutation contributed to this presumed bicalutamide-associated pneumonitis, because pneumonitis is an idiosyncratic druginduced "allergic" reaction; however, lung injury was reported in all the patients (Appendix Table A1). Pneumonitis of the contralateral lung 20 has been noted in ATM heterozygotes who have received breast or lung cancer radiation, and there is one report of lung abscopal 21 (remote) pneumonitis that recurred after pancreas cancer radiation. 22 Interstitial lung disease/pulmonary fibrosis is one of the most lethal forms of pulmonary disease in ATM homozygotes, 23…”