Reduction of radiation pneumonitis by V20-constraints in breast cancer

Abstract

IntroductionAdjuvant local-regional radiotherapy (LRRT) is routinely recommended for breast cancer patients. It is well known being related to pulmonary side-effects. We studied post-RT radiological changes on X-ray and CT, and correlated the findings with Quality of Life (QoL), common dosimetric factors and co-variates. The results were compared with a previously reported cohort of 137 irradiated women.Methods88 women underwent chest X-ray and CT pre-and 4-5 months after 3-D planned LRRT, minimizing the dose to the ipsilateral lung to V20 < 30%. The lung field was divided into 3 regions and the development of post-RT density changes were graded (0-3). Patients with radiological changes were compared with non-responders. Clinical symptoms were registered and data on patient and treatment related co-variates were gathered prospectively. The ipsilateral lung dosimetric factors V13, V20, V30 and mean dose were calculated and QoL was assessed before and 4 months after RT.ResultsThe use of dose-volume constraints significally reduced moderate-severe radiological changes on chest X-ray compared with our earlier study (Chi square trend test: p < 0.001). Symptomatic pneumonitis was also rare in the present study. No agreement was found between CT and chest X-ray as diagnostic tools for post-RT pneumonitis. V13 correlated independently with radiological changes on CT (logistic regression: p = 0.04; ROC area: 0.7). The Co-variates smoking habits, age, chemotherapy, endocrine or trastuzumab therapy did not influence the outcome on multivariate analysis. QoL changes in physical function, i.e. fatigue, dyspnoea were not detected but there was a trend for a worse recovery after chemotherapy in patients with high V13 (Spearman Rank Correlation: p < 0.05).ConclusionsThe use of dose-volume constraints significantly reduced post-RT radiological changes on chest X-ray in LRRT for BC. The lung changes on CT were also generally limited when we used this strategy and was not always picked up on chest X-ray. Variation in V13 alone was correlated with occurrence of lung changes on CT.

Predictive parameters for selection of electronic tissue compensation radiotherapy in early-stage breast cancer patients after breast-conserving surgery

“…The analysis showed that there are minimal differences between eComp and 3DCRT for the other parameters. In addition, according to literatures [8, 9, 37, 44] and protocols of our institution, those 3 quantities were generally considered as the determining factors in the normal tissue toxicities. In order to keep the consistency and to reduce plan differences caused by different planners, we decided that all plans were done by a single well-trained dosimetrist.…”

“…The correlation between heart dose-volume parameters and anatomic features was analyzed only for left-sided patients. Those dose-volume parameters were selected due to the fact that they are generally considered as the determining factors on the normal tissue toxicities [8, 30, 35, 37–44]. …”

The Rationale for Fractionation in Radiotherapy

“…These are by no means comprehensive and serve only to illustrate the destructive potential of radiation. Depending on the area irradiated, side effects include erectile dysfunction, dysuria, fistula formation, hematuria (Pinkawa et al, 2010), oral mucositis (D'haese et al, 2005), fatigue (Brunner & Scott-Brown, 2010), tooth decay (Corner & Bailey, 2008), nausea and vomiting (Souhami & Tobias, 2008), radiation pneumonitis, radiation fibrosis, nonproductive chronic cough formation (Goldman, Wennberg, Svane, Bylund, & Lind, 2010), cerebral edema and cognitive dysfunction (Baujat et al, 2010), dysphasia Peponi, Glanzmann, Willi, Huber, & Struder, 2011), blindness, hearing loss (Petsuksiri et al, 2011), acute nephritis, cystitis, and vaginal stenosis (Cairns, Harry, Sarkar, & Parkin, 2008).…”

Results of Early-Stage Breast Cancer Patients’ Treatment Using Accelerated Partial Breast Irradiation Technique After Breast-Conserving Surgery. Experience of N.N. Blokhin National Medical Research Center of Oncology

“…Из них 8841 (32 %) пациентка выбрала РМЭ, 18 648 (68 %) -органосохраняющее лечение. При этом среди больных с выполненной РМЭ боль-шинство (85 %) проживали на значительном расстоя-нии (8-65 км) до клиники [11].…”