Pulmonary Changes After Radiotherapy for Conservative Treatment of Breast Cancer: A Prospective Study

Krengli, Marco; Sacco, M; Loi, G.; Masini, Laura; Ferrante, Daniela; Gambaro, G.; Ronco, Marco; Magnani, Corrado; Carriero, Alessandro

doi:10.1016/j.ijrobp.2007.08.050

Cited by 80 publications

(66 citation statements)

References 24 publications

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“…These results are consistent with the results of studies of late pulmonary disease after radiation therapy for breast cancer. [35][36][37] The low frequency of lymphedema (10.5% in the control group and 12.0% in the nodal-irradiation group) is probably due to the fact that the operated part of the axilla was not irradiated unless adverse risk factors were present. Overall, only 7.4% of patients in the control group and 8.3% in the nodal-irradiation group underwent irradiation to the axilla.…”

Section: Discussionmentioning

confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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BACKGROUND The effect of internal mammary and medial supraclavicular lymph-node irradiation (regional nodal irradiation) added to whole-breast or thoracic-wall irradiation after surgery on survival among women with early-stage breast cancer is unknown. METHODS We randomly assigned women who had a centrally or medially located primary tumor, irrespective of axillary involvement, or an externally located tumor with axillary involvement to undergo either whole-breast or thoracic-wall irradiation in addition to regional nodal irradiation (nodal-irradiation group) or whole-breast or thoracicwall irradiation alone (control group). The primary end point was overall survival. Secondary end points were the rates of disease-free survival, survival free from distant disease, and death from breast cancer. RESULTS Between 1996 and 2004, a total of 4004 patients underwent randomization. The majority of patients (76.1%) underwent breast-conserving surgery. After mastectomy, 73.4% of the patients in both groups underwent chest-wall irradiation. Nearly all patients with node-positive disease (99.0%) and 66.3% of patients with node-negative disease received adjuvant systemic treatment. At a median followup of 10.9 years, 811 patients had died. At 10 years, overall survival was 82.3% in the nodal-irradiation group and 80.7% in the control group (hazard ratio for death with nodal irradiation, 0.87; 95% confidence interval [CI], 0.76 to 1.00; P=0.06). The rate of disease-free survival was 72.1% in the nodal-irradiation group and 69.1% in the control group (hazard ratio for disease progression or death, 0.89; 95% CI, 0.80 to 1.00; P=0.04), the rate of distant disease-free survival was 78.0% versus 75.0% (hazard ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02), and breast-cancer mortality was 12.5% versus 14.4% (hazard ratio, 0.82; 95% CI, 0.70 to 0.97; P=0.02). Acute side effects of regional nodal irradiation were modest. CONCLUSIONS In patients with early-stage breast cancer, irradiation of the regional nodes had a marginal effect on overall survival. Disease-free survival and distant disease-free survival were improved, and breast-cancer mortality was reduced. (Funded by Fonds Cancer; ClinicalTrials.gov number, NCT00002851.).

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Section: Discussionmentioning

confidence: 99%

Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer

Collette²,

et al. 2015

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“…Radiation pneumonitis is an acute exudative inflammatory process, typically occurring within 1-4 months after RT, which follows the initial damage of cells in the alveolar space (pneumocytes, fibroblasts, endothelial cells and macrophages; [11]). Pulmonary fibrosis is a late injury due to interstitial damage involving the parenchyma and pleura [12]. Radiation damage can also cause endothelial cell damage and atherosclerosis [13], myocardial ischemia and fibrosis [14].…”

Section: Radiotherapy Side Effectsmentioning

confidence: 99%

Breast cancer subtypes: response to radiotherapy and potential radiosensitisation

Langlands

Horgan²,

Dodwell³

et al. 2013

The British Journal of Radiology

107

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“…The probability of pulmonary side effects is linked to lung dose, fraction dose and volume [13,17], but its clinical significance has been shown to correlate with lung mass. It has to be kept in mind, however, that a DIBH technique increases the volume of lung receiving varying doses, which may "drain the gain", if one postulates that volume/dose is the dominant risk factor for lung tissue damage.…”

Section: Introductionmentioning

confidence: 99%