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Open Access 01-06-2018 | Original Article

Occurrence of pneumonitis following radiotherapy of breast cancer – A prospective study

Authors: Danijela Vasiljevic, Christoph Arnold, David Neuman, Katharina Fink, Marina Popovscaia, Irma Kvitsaridze, Meinhard Nevinny-Stickel, Markus Glatzer, Peter Lukas, Thomas Seppi

Published in: Strahlentherapie und Onkologie | Issue 6/2018

Abstract

Aim

of this study is to determine the temporal resolution of therapy-induced pneumonitis, and to assess promoting factors in adjuvant treated patients with unilateral mammacarcinoma.

Patients and methods

A total of 100 post-surgery patients were recruited. The cohort was treated by 2 field radiotherapy (2FRT; breast and chest wall, N = 75), 3 field radiotherapy (3FRT; + supraclavicular lymphatic region, N = 8), or with 4 field radiotherapy (4FRT; + parasternal lymphatic region, N = 17). Ninety-one patients received various systemic treatments prior to irradiation. Following an initial screening visit post-RT, two additional visits after 12 and 25 weeks were conducted including radiographic examination. In addition, general anamnesis and the co-medication were recorded. The endpoint was reached as soon as a pneumonitis was developed or at maximum of six months post-treatment.

Results

A pneumonitis incidence of 13% was determined. Of 91 patients with prior systemic therapy, 11 patients developed pneumonitis. Smoking history and chronic obstructive pulmonary disease (COPD) appeared to be positive predictors, whereas past pneumonia clearly promoted pneumonitis. Further pneumonitis-promoting predictors are represented by the applied field extensions (2 field radiotherapy [2FRT] < 3 field radiotherapy [3FRT] < 4 field radiotherapy [4FRT]) and the type of combined initial systemic therapies. As a consequence, all of the three patients in the study cohort treated with 4FRT and initial chemotherapy combined with anti-hormone and antibody protocols developed pneumonitis. A combination of the hormone antagonists tamoxifen and goserelin might enhance the risk for pneumonitis. Remarkably, none of the 11 patients co-medicated with statins suffered from pneumonitis.

Conclusions

The rapidly increasing use of novel systemic therapy schedules combined with radiotherapy (RT) needs more prospective studies with larger cohorts. Our results indicate that contribution to pneumonitis occurrence of various (neo)adjuvant therapy approaches followed by RT is of minor relevance, whereas mean total lung doses of >10 Gy escalate the risk of lung tissue complications. The validity of potential inhibitors of therapy-induced pneumonitis as observed for statin co-medication should further be investigated in future trials.

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Title: Occurrence of pneumonitis following radiotherapy of breast cancer – A prospective study
Authors: Danijela Vasiljevic
Christoph Arnold
David Neuman
Katharina Fink
Marina Popovscaia
Irma Kvitsaridze
Meinhard Nevinny-Stickel
Markus Glatzer
Peter Lukas
Thomas Seppi
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Strahlentherapie und Onkologie / Issue 6/2018
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1257-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Occurrence of pneumonitis following radiotherapy of breast cancer – A prospective study

Abstract

Aim

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aim

Patients and methods

Results

Conclusions

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