Multivariate analysis of pulmonary fibrosis after electron beam irradiation for postmastectomy chest wall and regional lymphatics: evidence for non-dosimetric factors

• Published in: Radiotherapy and oncology 2000-10, Vol.57 (1), p.91-96
• Main Authors: Huang, Eng-Yen, Wang, Chong-Jong, Chen, Hui-Chun, Sun, Li-Min, Fang, Fu-Min, Yeh, Shyh-An, Hsu, Hsuan-Chih, Hsiung, Ching-Yeh, Wu, Jia-Ming
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Chemotherapy, Adjuvant; Chest wall; Chi-Square Distribution; Cyclophosphamide - administration & dosage; Cytarabine - administration & dosage; Dose-Response Relationship, Radiation; Electron beam; Epirubicin - administration & dosage; Female; Fluorouracil - administration & dosage; Humans; Incidence; Logistic Models; Lymph Nodes - radiation effects; Mastectomy, Segmental; Methotrexate - administration & dosage; Middle Aged; Neoplasm Staging; Postmastectomy; Prospective Studies; Pulmonary fibrosis; Pulmonary Fibrosis - epidemiology; Pulmonary Fibrosis - etiology; Radiation Dosage; Radiation Tolerance; Radiotherapy, Adjuvant - adverse effects; Radiotherapy, High-Energy - adverse effects; Radiotherapy, High-Energy - methods; Risk Factors; Statistics, Nonparametric; Thorax - radiation effects
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/S0167-8140(00)00211-5

Background and purpose: To evaluate the factors associated with pulmonary fibrosis after postmastectomy electron beam irradiation of chest wall and regional lymphatics in patients with breast cancer. Materials and methods: From July 1987 through July 1994, 109 women with stage II and III breast cancer receiving modified radical mastectomies were managed by postoperative electron beam irradiation. Doses of 46 to 50.4 Gy were delivered to the chest wall covered with bolus, internal mammary nodes, supraclavicular nodes and axillary lymph nodes via 12 or 15 MeV single portal electron beam. Seventeen patients received additional 10–16 Gy surgical scar boost via 9 MeV electron beam. Comparison of pre-treatment and post-treatment chest X-ray films were used to monitor the development of pulmonary fibrosis. Results: Only Grade 1 radiation-induced late pulmonary toxicity was noted in 33 patients (29%). Twenty-six patients (24%) developed pulmonary fibrosis under unbolused chest wall. Lung fibrosis under bolused chest wall was noted in 11 patients (10%). Statistical difference ( P