Parm. Lind et al., Pulmonary complications following different radiotherapy techniques for breast cancer, and the association to irradiated lung volume and dose, BREAST CANC, 68(3), 2001, pp. 199-210
Purpose. This study investigates the incidence of short-term pulmonary comp
lications following radiotherapy (RT) for breast cancer (BC) with different
treatment techniques/incidentally irradiated lung volumes and the importan
ce 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 h
istograms (MDVH) were constructed and compared for the different RT-techniq
ues. Among a subset of the mastectomized patients treated with loco-regiona
l (LR-) RT, who had undergone complete three-dimensional (3-D) dose plannin
g (n= 43), MDVH for asymptomatic patients was compared with MDVH for patien
ts 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 increas
ing irradiated lung volumes at the > 20 Gy-level (V(2)0), based on MDVH for
the RT-techniques, and pulmonary complications was found (P < 0.001). Furt
hermore, increasing age and reduced pre-RT functional level were independen
tly associated with a higher rate of pulmonary complications (P = 0.005 and
P = 0.018). Among the subgroup of mastectomized patients treated with LR-R
T, who had undergone complete 3-D dose planning, a difference in mean V(2)0
was found between patients experiencing both clinical and radiological pul
monary side-effects compared to patients experiencing neither of the two si
de-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 guidel
ines for these RT-techniques, 3-D RT planning can be used.