Pneumonitis and fibrosis after breast cancer radiotherapy: occurrence and treatment-related predictors. (2nd December 2021)

• Record Type: Journal Article
• Authors: Karlsen, Jarle; Tandstad, Torgrim; Sowa, Piotr; Salvesen, Øyvind; Stenehjem, Jo S.; Lundgren, Steinar; Reidunsdatter, Randi J.
• Is Part Of: Acta oncologica. Volume 60:Number 12(2021)
• Page Start: 1651
• Page End: 1658
• Publication Date: 2021-12-02
• Subjects: Oncology -- Periodicals; Cancer -- Treatment -- Periodicals; 616.992
• DOI: 10.1080/0284186X.2021.1976828
• Languages: English
• ISSNs: 0284-186X

Abstract

Abstract: Background: Radiation pneumonitis (RP) and radiation fibrosis (RF) are common side effects after breast cancer (BC) radiotherapy (RT). However, there is a great variation in the frequency of RP and RF. This study presents the occurrence of- and the treatment-related predictors for RP and RF. Further, physician- and patient-reported pulmonary symptoms during the first year after postoperative RT for BC are demonstrated. Materials and methods: From 2007 to 2008, 250 BC patients referred for postoperative RT were included in a prospective cohort study and followed during the first year after RT. High-resolution computed tomography of the lungs and symptom registration were performed before RT and 3, 6, and 12 months after RT. Patient-reported symptoms were registered by standard quality of life questionnaires. Logistic regression analyses were applied to estimate treatment-related predictors for radiological RP (rRP), clinical RP (cRP), radiological RF (rRF), and clinical RF (cRF). Results: The occurrence of rRP and cRP at three months was 78% and 19%, while 12 months after RT rRF and cRF was 89% and 16%, respectively; all reported as grade 1. In multivariable analyses, mastectomy predicted cRP at three months (OR = 2.48, p = .03) and cRF at six months, ipsilateral lung volume receiving 20 Gray or more (V20), V30, and mean lung dose (MLD) predicted rRP at six months (OR = 1.06, p = .0003; OR = 1.10, p = .001; and OR = 1.03, p = .01, respectively). Endocrine treatment predicted cRF at 12 months (OR = 2.48, p = .02). Physicians reported significant more dyspnea at 3 months ( p = .003) and patients reported 'a little dyspnea' more at 3 and 12 months compared to baseline ( p = .007). Conclusion: RP and RF are prevalent in the first year after BC radiation. Mastectomy predicted cRP at three months. V20, V30, D25, and MLD predicted rRP at 6 months, and endocrine treatment predicted cRF at 12 months. Patients and physicians reported dyspnea differently.