Pneumonitis and fibrosis after breast cancer radiotherapy: occurrence and treatment-related predictors

Authors

  • Jarle Karlsen Department of Oncology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
  • Torgrim Tandstad Department of Oncology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
  • Piotr Sowa Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
  • Øyvind Salvesen Department of Cancer Research and Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
  • Jo S. Stenehjem Department of Research, Cancer Registry of Norway, Oslo, Norway
  • Steinar Lundgren Department of Oncology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
  • Randi J. Reidunsdatter Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway

DOI:

https://doi.org/10.1080/0284186X.2021.1976828

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.

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Published

2021-10-07

How to Cite

Karlsen, J., Tandstad, T., Sowa, P., Salvesen, Øyvind, Stenehjem, J. S., Lundgren, S., & Reidunsdatter, R. J. (2021). Pneumonitis and fibrosis after breast cancer radiotherapy: occurrence and treatment-related predictors. Acta Oncologica, 60(12), 1651–1658. https://doi.org/10.1080/0284186X.2021.1976828

Issue

Vol. 60 No. 12 (2021): Acta Oncologica

Section

Articles