Abnormalities on chest radiographs following radiation therapy for breast cancer

The aim of this study was to study pulmonary radiological abnormalities wit h chest radiography following different radiotherapy (RT) techniques for br east cancer with respect to regions and density, and their association with pulmonary complications and reduction in vital capacity (VC). Chest radiog raphs were performed 5 months following local or loco-regional RT in 167 br east cancer patients. The radiological abnormalities were analysed with a c lassification system originally proposed by Arriagada and evaluated accordi ng to increasing density (0-3) and affected lung regions (apical-lateral, b asal-lateral, central-parahilar). The highest-density grades in each region were added together to form scores ranging from 0 to 9. The patients were monitored for RT-induced pulmonary complications. The VC was measured prior to and 5 months following RT. An independent evaluation of 5. patients was performed by a second radiologist to control the reproducibility of the cl assification system. Increasing scores were associated with loco-regional R T and pulmonary complications (P < 0.001). The mean reduction of VC for pat ients scoring 0-3 (-30 mi) vs 4-9 (-161 mi) was not statistically significa nt (P = 0.10). Scores of 4-9 were more frequently observed in older patient s (P < 0.001). The independent evaluations by two radiologists revealed goo d agreement (P < 0.001) and no systematic inter-observer variation. Radiolo gical abnormalities on chest radiographs, scored according to Arriagada, ca n be used as an objective end point for RT-induced pulmonary side effects i n breast cancer.