Radiation pneumonitis and pulmonary function with lung dose-volume constraints in breast cancer irradiation

We studied symptomatic radiation pneumonitis (RP) and changes in pulmonary function tests (PFTs) after loco-regional radiotherapy (LRRT) with V₂₀ lung constraints in breast cancer (BC).

Sixty-four women underwent PFTs before and 5 months after 3D planned LRRT for BC. The incidentally irradiated ipsilateral lung V₂₀ was minimised to <30%. Patients were monitored for symptoms of RP 1, 4 and 7 months after radiotherapy (RT) and data on covariates were collected prospectively. The outcome was compared with previous treatment series.

Pneumonitis was less frequent with the applied constraint, that is, four mild and one moderate case, than in our previous report (p < 0·001). In multivariate analyses, neither dosimetric data nor covariates appeared to influence mean changes in vital capacity [-0·11L, standard error of the mean (SEM) 0·03] or diffusing capacity of the lung for carbon monoxide (DLCO) (-0·20 mmol/kPa/min, SEM 0·01), except for pre-RT chemotherapy, which diminished the change in DLCO 5 months post-RT.

The used constraint and 3D planning lowered the rate of RP and short-term changes in PFTs compared with our previous treatment series. Pre-RT chemotherapy affects DLCO baseline levels. Rates of side effects should be continuously studied when new target definitions or therapies are introduced in LRRT of BC.