Bilateral lymphocytic alveolitis: a common reaction after unilateral thoracic irradiation

The main aim of the present study was to assess the early diagnostic value of bronchoalveolar lavage (BAL) in radiation-induced lung injury in patient s with breast carcinoma. Twenty-six females receiving postoperative radiotherapy for breast cancer w ere evaluated before and 0, 15, 30, 60, and 180 days after radiotherapy. Hi story, physical examination, chest radiographs, and pulmonary function test s were obtained. BAL, including lymphocyte subsets analysis, was limited to the second evaluation after radiotherapy. A group of 21 healthy females we re used as control. Findings after radiotherapy in asymptomatic patients we re compared with findings in a group of patients with radiation pneumonitis . Irradiated patients showed a significantly (p<0.01) greater percentage (29. 5+/-15.7%) of BAL lymphocytes than controls (6.2+/-3.3%). No statistical di fferences existed in BAL findings between the irradiated and unirradiated s ides of the chest. Percentages of BAL lymphocytes did not differ significan tly between patients who developed subsequent pneumonitis (24.5+/-13.5%) an d those who did not develop pneumonitis (32.8+/-16.5%). Patients with pneum onitis at the time of BAL, had significantly higher (p<0.05) alveolar CD4 s ubset cells (24.8+/-10.2%) than asymptomatic patients (15.2+/-8.9%). Maxima l reductions in total lung capacity (p<0.01), and residual volume (p<0.05) occurred 60 days after irradiation. The early lymphocytic alveolitis induced by unilateral thoracic radiotherap y in most patients with breast cancer is always bilateral and does not pred ict the subsequent development of radiological evidence of pneumonitis.