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Pulmonary complications following different radiotherapy techniques for breast cancer, and the association to irradiated lung volume and dose

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Abstract

Purpose. This study investigates the incidence of short-term pulmonary complications following radiotherapy (RT) for breast cancer (BC) with different treatment techniques/incidentally irradiated lung volumes and the importance of confounding factors on RT-induced pulmonary complications.

Patients and methods. Prospectively, 475 patients with BC were followed for pulmonary complications 1, 4 and 7 months post-RT. Mean lung dose volume histograms (MDVH) were constructed and compared for the different RT-techniques. Among a subset of the mastectomized patients treated with loco-regional (LR-) RT, who had undergone complete three-dimensional (3-D) dose planning (n= 43), MDVH for asymptomatic patients was compared with MDVH for patients experiencing both radiological and clinical pulmonary side-effects.

Results. Moderate pulmonary complications, that is requiring treatment with corticosteroids, were rare following local RT ( < 1%), but were diagnosed among 11% of the patients treated with LR-RT. A correlation between increasing irradiated lung volumes at the > 20 Gy-level (V20), based on MDVH for the RT-techniques, and pulmonary complications was found (P < 0.001). Furthermore, increasing age and reduced pre-RT functional level were independently associated with a higher rate of pulmonary complications (P = 0.005 and P = 0.018). Among the subgroup of mastectomized patients treated with LR-RT, who had undergone complete 3-D dose planning, a difference in mean V20 was found between patients experiencing both clinical and radiological pulmonary side-effects compared to patients experiencing neither of the two side-effects (P = 0.007).

Conclusion. Moderate pulmonary complications following local RT for BC are rare. The incidence of short-term moderate pulmonary complications in LR-RT is, however, clinically significant and to define quality assurance guidelines for these RT-techniques, 3-D RT planning can be used.

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Authors and Affiliations

  1. Department of Radiotherapy, Huddinge University Hospital, Sweden

    Pehr A.R.M Lind

  2. Department of Radiation Oncology, Duke University Medical Center, North Carolina, USA

    Pehr A.R.M Lind

  3. Department of Medical Physics, Huddinge University Hospital, Sweden

    Berit Wennberg

  4. Department of Hospital Physics, Karolinska Hospital, Stockholm, Sweden

    Giovanna Gagliardi

  5. Department of Radiotherapy, Huddinge University Hospital, Sweden

    Tommy Fornander

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Lind, P.A., Wennberg, B., Gagliardi, G. et al. Pulmonary complications following different radiotherapy techniques for breast cancer, and the association to irradiated lung volume and dose. Breast Cancer Res Treat 68, 199–210 (2001). https://doi.org/10.1023/A:1012292019599

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