Bronchiolitis obliterans organizing pneumonia syndrome primed by radiationtherapy to the breast

Reports of bronchiolitis obliterans organizing pneumonia (BOOP) occurring i n women after radiation therapy for breast cancer have suggested that radia tion to the lung could participate in the development of BOOR. We now descr ibe the clinical, radiographic, functional, and bronchoalveolar lavage char acteristics of this syndrome in a series of 15 patients reported to the Gro upe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (CER M"O"P) in France. All 15 women (60 +/- 6 yr of age) fulfilled the following inclusion criteria: (1) radiation therapy to the breast within 12 mo, (2) general and/or respiratory symptoms lasting for at least 2 wk, (3) lung inf iltrates outside the radiation port, and (4) no specific cause. The patient s presented with fever, nonproductive cough, mild dyspnea, and peripheral a lveolar opacities on chest radiograph with a characteristic migratory patte rn. In five patients, ROOF was found at lung pathologic analysis. In all th e patients dramatic improvement was obtained with corticosteroids, but rela pses occurred in 12 patients while tapering or after stopping corticosteroi ds. This report demonstrates that a characteristic BOOP syndrome may occur after radiation therapy to the breast, including tangential radiation to th e lung, thus suggesting that radiation therapy may prime the development of ROOF.