I Fragkandrea1, V Kouloulias2, P Mavridis3, A Zettos4, S Betsou5, P Georgolopoulou5, A Sotiropoulou5, A Gouliamos6, I Kouvaris6. 1. The Neurooncology Department, The Royal Marsden Hospital, London, UK. 2. Radiotherapy Department, Attikon Hospital, Athens, Greece. 3. Paediatric Department, Hippokrateion Hospital, Thessaloniki, Greece. 4. Lung Unit, St Savvas Oncology Hospital Athens, Greece. 5. Radiotherapy Physics Department, St Savvas Oncology Hospital, Athens, Greece. 6. Academic Radiology Department, Aretaieion Hospital, Kapodistriakon University, Athens, Greece.
Abstract
BACKGROUND:Hypofractionated Radiotherapy (RT) regimens for breast cancer, although reduce cost and time for patients and health care systems, could have a negative impact on normal underlying lung tissue. We studied and compared lung function and the post-RT radiological changes using High-Resolution Computed Tomography (HRCT) in early breast cancer patients, treated with 3-Dimentional conformal whole breast radiotherapy (WBRT) using either conventional or hypofractionated regime. PATIENTS AND METHODS: Between 2008 and 2009, 61 early breast cancer patients (T1-2N0M0) were randomised into two groups .Group A (n=31) received standard radiotherapy with 50Gy/25f/5w plus boost 10Gy/5f/1w to tumour bed. Group B (n=30) received 43.2Gy/16f/22d plus boost 10Gy/5f/1w to tumour bed. Patients of both groups were subjected to dynamic lung testing, using spirometry and gas diffusion tests on Day 0 (D0, before RT), during RT and after completion of RT at 3 and 6 months. HRCT scans were performed in all patients at baseline, and 3,6,12 months after completion of RT. Respiratory symptoms were recorded at 3 and 6 months post completion of RT. Dosimetric factors, such as Central Lung Dose (CLD), lung Volume receiving more 20 Gy (V20), D25 and Mean Lung Dose (MLD) were calculated for all patients. RESULTS: At 3 months after RT, the pulmonary changes were classified at HRCT as follows: 91.8 % were Grade 0, 8.19 % Grade 1, and 0 % Grade 2. At 6 months, 86.98 % were Grade 0, 11.47 % Grade 1, and 1.6 % Grade 2. At 12 months, 88.52 % were Grade 0, 9.19 % Grade 1 and 3.27% Grade 2. Univariate analysis showed strong association between radiation pneumonitis, age and all dosimetric parameters. There was no association between fractionation type and incidence of RN. FEV1, FVC, FEV 25, FEV 50 and DLCO showed no statistically significant reduction in both treatment groups in 3 and 6 months following completion of RT, compared to baseline. Multivariate analysis showed no relation between HRCT findings and other variables (age, smoking, chemotherapy, hormonotherapy, V20). CONCLUSION:Lung toxicity, as assessed with HRCT and PFTs, was minimal in both treatment arms and our results are in consistency with other published data. Hypofractionated RT was a safe modality and well tolerated by the majority of the patients. Longer follow-up is required for robust assessment of incidence of late lung fibrosis in our series.
RCT Entities:
BACKGROUND: Hypofractionated Radiotherapy (RT) regimens for breast cancer, although reduce cost and time for patients and health care systems, could have a negative impact on normal underlying lung tissue. We studied and compared lung function and the post-RT radiological changes using High-Resolution Computed Tomography (HRCT) in early breast cancerpatients, treated with 3-Dimentional conformal whole breast radiotherapy (WBRT) using either conventional or hypofractionated regime. PATIENTS AND METHODS: Between 2008 and 2009, 61 early breast cancerpatients (T1-2N0M0) were randomised into two groups .Group A (n=31) received standard radiotherapy with 50Gy/25f/5w plus boost 10Gy/5f/1w to tumour bed. Group B (n=30) received 43.2Gy/16f/22d plus boost 10Gy/5f/1w to tumour bed. Patients of both groups were subjected to dynamic lung testing, using spirometry and gas diffusion tests on Day 0 (D0, before RT), during RT and after completion of RT at 3 and 6 months. HRCT scans were performed in all patients at baseline, and 3,6,12 months after completion of RT. Respiratory symptoms were recorded at 3 and 6 months post completion of RT. Dosimetric factors, such as Central Lung Dose (CLD), lung Volume receiving more 20 Gy (V20), D25 and Mean Lung Dose (MLD) were calculated for all patients. RESULTS: At 3 months after RT, the pulmonary changes were classified at HRCT as follows: 91.8 % were Grade 0, 8.19 % Grade 1, and 0 % Grade 2. At 6 months, 86.98 % were Grade 0, 11.47 % Grade 1, and 1.6 % Grade 2. At 12 months, 88.52 % were Grade 0, 9.19 % Grade 1 and 3.27% Grade 2. Univariate analysis showed strong association between radiation pneumonitis, age and all dosimetric parameters. There was no association between fractionation type and incidence of RN. FEV1, FVC, FEV 25, FEV 50 and DLCO showed no statistically significant reduction in both treatment groups in 3 and 6 months following completion of RT, compared to baseline. Multivariate analysis showed no relation between HRCT findings and other variables (age, smoking, chemotherapy, hormonotherapy, V20). CONCLUSION: Lung toxicity, as assessed with HRCT and PFTs, was minimal in both treatment arms and our results are in consistency with other published data. Hypofractionated RT was a safe modality and well tolerated by the majority of the patients. Longer follow-up is required for robust assessment of incidence of late lung fibrosis in our series.
Entities:
Keywords:
Hypofractionated breast radiotherapy; high resolution computed tomography; radiation pneumonitis; spirometric tests; whole breast radiotherapy
Authors: Pehr A R M Lind; Lawrence B Marks; Patricia H Hardenbergh; Robert Clough; Ming Fan; Donna Hollis; Maria Lourdes Hernando; Daniel Lucas; Anna Piepgrass; Leonard R Prosnitz Journal: Int J Radiat Oncol Biol Phys Date: 2002-01-01 Impact factor: 7.038
Authors: Timothy Whelan; Robert MacKenzie; Jim Julian; Mark Levine; Wendy Shelley; Laval Grimard; Barbara Lada; Himu Lukka; Francisco Perera; Anthony Fyles; Ethan Laukkanen; Sunil Gulavita; Veronique Benk; Barbara Szechtman Journal: J Natl Cancer Inst Date: 2002-08-07 Impact factor: 13.506
Authors: Javier Jaén; Gonzalo Vázquez; Enrique Alonso; Maria D De Las Peñas; Laura Díaz; Manuel De Las Heras; José F Pérez-Regadera Journal: Int J Radiat Oncol Biol Phys Date: 2012-08-25 Impact factor: 7.038
Authors: M Valli; S Cima; D Gaudino; R Cartolari; L Deantonio; M Frapolli; D Daniele; G A Pesce; F Martucci; N C Azinwi; D Bosetti; S Presilla; A Richetti Journal: Clin Transl Oncol Date: 2019-03-14 Impact factor: 3.405
Authors: Ana Aurora Díaz Gavela; Blanca Vaquero Barrón; Elia Del Cerro Peñalver; Felipe Couñago Journal: Transl Cancer Res Date: 2020-01 Impact factor: 1.241