Sequential pulmonary effects of radiotherapy detected by functional and radiological end points in women with breast cancer

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) 2005-02, Vol.17 (1), p.39-46
• Main Authors: Tokatli, F., Kaya, M., Kocak, Z., Ture, M., Mert, S., Unlu, E., Alkaya, F., Cakir, B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Breast cancer; Breast Neoplasms - radiotherapy; computed tomography; Endpoint Determination; Female; Functional Laterality; Humans; Lung - diagnostic imaging; Lung - physiology; Lung - radiation effects; Middle Aged; Prospective Studies; pulmonary function tests; Radiation Injuries - diagnostic imaging; Radiation Injuries - etiology; radiation-induced pulmonary injury; Radionuclide Imaging; Radiopharmaceuticals; Respiratory Function Tests; Sensitivity and Specificity; Tc-99m DTPA lung clearance scintigraphy; Technetium Tc 99m Pentetate; Treatment Outcome
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2004.07.012

To determine the pulmonary effects of locoregional irradiation on clinical and sub-clinical radiographic and functional end points in women with breast cancer, and whether the course of these end points is affected by laterality. Twenty patients (10 irradiated on the left side and 10 irradiated on the right side) were prospectively evaluated for changes in pulmonary function tests, Tc-99m DTPA (diethylenetriamine pentaacetic acid) lung clearance scintigraphy and high-resolution computed tomography (HRCT) at 6, 16 and 52 weeks after radiotherapy. Tc-99m DTPA clearance, expressed as the biological half-time, T 1/2, was computed from the time–activity curves for 10 min for each lung. The irradiated lung volume was calculated for each patient. The mean irradiated lung volume was 6.4% ± 2 (range 3–11%) for the entire population. In the whole study population, two (10%) patients, who were irradiated on the left side, had mild symptomatic radiation pneumonitis in the follow-up period. There was a statistically significant gradual reduction in all pulmonary function test values during the follow-up period. For patients irradiated on the left side, Tc-99m DTPA clearance T 1/2 values were statistically significantly decreased during the follow-up period ( P = 0.03), but the decrease was not statistically significant for patients irradiated on the right side ( P = 0.62). Tc-99m DTPA clearance T 1/2 values were statistically significantly decreased in the irradiated lung compared with the opposite lung, and no improvement was seen at week 52 after radiotherapy. The number of patients with changes on HRCT scans increased after radiotherapy, reaching a maximum at 16 weeks, when 80% of patients had changes. There was subsequent partial recovery 52 weeks after radiotherapy. Locoregional irradiation for breast cancer may cause sub-clinical irreversible impairment of radiological and functional pulmonary parameters. The increase in clearance rate of Tc-99m DTPA may be more prominent for patients with left-sided breast cancer.