[Changes in the chest x-ray following postoperative irradiation of breast cancer]

The radiogenic modifications of the thorax radiography were evaluated in 100 patients irradiated postoperatively for mammary carcinoma between January, 1980 and March, 1983. No adjuvant chemotherapy was given. A telecobalt unit was used for the irradiations. A computer-assisted planning (Evados) was applied in order to obtain an individual optimization especially for the fields situated at the thoracic walls. The average focal doses to the thoracic wall and the regional lymph nodes were between 50 and 52 Gy. Taking into consideration all modifications visualized by radiography, 65% of patients had subacute radiogenic reactions in the lungs, especially in the apex fields. In general the modifications had no clinical importance. Only seven patients presented more severe forms of pneumonitis with clinical symptoms. Fibroses were developed only in the apex fields; infraclavicular infiltrations were seen only in exceptional cases. There were no costal necroses, essential pleural reactions, or radiogenic enlargements of the heart shadow. The rate of pulmonary reactions with clinical symptoms is reduced as compared with former techniques, e.g. opposing tangential fields. The knowledge of anamnesis and typical radiographic modifications should help to avoid problems of differentiation between apex reactions and tuberculosis.