Document Type : Original Article

Authors

1 Department Of Radiation Oncology, Kerman University of Medical Sciences, Kerman, Iran

2 Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

3 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

4 Department of Psychiatry, Sirjan School of Medical Sciences, Sirjan, Iran

Abstract

Background: The aim of this study was to determine pulmonary complications induced by radiotherapy and chemotherapy in patients with breast cancer in a six-month follow-up.
Method: 80 patients with breast cancer who were referred to the Radio-oncology Center in Kerman were included in the current cohort study.
At the baseline, spirometry and lung scan were obtained and all the patients were asked about their respiratory symptoms. After designing the patient’s treatment, dose volume histogram data was extracted. All the tests were repeated six months after radiotherapy. The prevalence of pneumonitis and fibrosis in radiographs were determined clinically and the reduction in the values of pulmonary function test parameters was determined.
Results: In 40% of the patients, pulmonary volume was reduced and in 10%, pulmonary fibrosis occurred. Regarding pulmonary function before and six months after radiotherapy, the results revealed that FeV1 (l/s) parameter decreased from 2.68 to 2.48 (P < 0.0001) six months after radiotherapy. FVC parameter also showed a decrease from 3.14 to 2.91 (P < 0.0001) in the same span of time. The odds of developing clinical symptoms in people with pulmonary fibrosis was five times higher than of those without this condition, (odds ratio: 5.51, 95% confidence interval: 1.10 - 27. 42), which was statistically significant (P = 0.03). None of the factors, including mean lung dose, tamoxifen, and age, affected Fev1 and pulmonary fibrosis.
Conclusion: Our results indicated that 10% of the patients undergoing treatment for breast cancer developed pulmonary fibrosis and 40% of the patients suffered from reduced pulmonary volumes, which was not associated with chemotherapy regimen or the use of tamoxifen.

Keywords

How to cite this article:

Bahador M, Larizadeh MH, Samareh Fekri M, Naghibzadeh-Tahami A, Mohseni M, Arabnejad F. Investigation of pulmonary complications induced by radiotherapy and chemotherapy in patients with breast cancer through spirometry, CT scan imaging patterns, and clinical criteria in a six-month follow-up. Middle East J Cancer. 2022;13(4):692-700. doi: 10.30476/mejc.2021.88710.1490.

Shieh Y, Tice JA. Medications for primary prevention of breast cancer. JAMA. 2020;324(3):291-2. doi:10.1001/jama.2020.9246.
2. Mohammadifard M, khazaee Z, Mohammadifard M. The needs for screening of breast cancer, based on the latest guidelines. [In Persian] J Birjand Univ Med Sci. 2019;26(1):1-3 doi: 10.32592/JBirjandUnivMedSci.2019.26.1.100.
3. Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, et al. Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2018;68(4):297-316. doi: 10.3322/caac.21446.
4. Wild CP. The global cancer burden: necessity is the mother of prevention. Nat Rev Cancer. 2019;19(3):123-4. doi: 10.1038/s41568-019-0110-3.
5. Jeba J, Isiah R, Subhashini J, Backianathan S, Thangakunam B, Christopher DJ. Radiation pneumonitis after conventional radiotherapy for breast cancer: A prospective study. J Clin Diagn Res. 2015;9(7):XC01-XC05. doi: 10.7860/JCDR/2015/ 13969.6211.
6. Aznar MC, Duane FK, Darby SC, Wang Z, Taylor CW. Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010-2015. Radiother Oncol. 2018;126(1): 148-54. doi: 10.1016/j.radonc.2017.11.022.
7. AlSaeed EF, Balaraj FK, Tunio MA. Changes in pulmonary function tests in breast carcinoma patients treated with locoregional post-mastectomy radiotherapy: results of a pilot study. Breast Cancer (Dove Med Press). 2017;9:375-81. doi: 10.2147/ BCTT.S114575.
8. Palma DA, Senan S, Tsujino K, Barriger RB, Rengan R, Moreno M, et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: an international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2013;85(2):444-50. doi: 10.1016/j.ijrobp.2012.04.043.
9. Lee TF, Chao PJ, Chang L, Ting HM, Huang YJ. Developing multivariable normal tissue complication probability model to predict the incidence of symptomatic radiation pneumonitis among breast cancer patients. PLoS One. 2015;10(7):e0131736. doi: 10.1371/journal.pone.0131736.
10. Omarini C, Thanopoulou E, Johnston SR. Pneumonitis and pulmonary fibrosis associated with breast cancer treatments. Breast Cancer Res Treat. 2014;146(2):245-58. doi: 10.1007/s10549-014-3016-5.
11. Giridhar P, Mallick S, Rath GK, Julka PK. Radiation induced lung injury: prediction, assessment and management. Asian Pac J Cancer Prev. 2015;16(7): 2613-7. doi: 10.7314/apjcp.2015.16.7.2613.
12. Delaney GP, Barton MB. Evidence-based estimates of the demand for radiotherapy. Clin Oncol (R Coll Radiol). 2015;27(2):70-6. doi: 10.1016/j.clon. 2014.10.005.
13. Vasiljevic D, Arnold C, Neuman D. Occurrence of pneumonitis following radiotherapy of breast cancer - A prospective study. Strahlenther Onkol. 2018; 194: 520-32. doi: 10.1007/s00066-017-1257-z.
14. Goldman U, Svane G, Anderson M, Wennberg B. Long-term functional and radiological pulmonary changes after radiation therapy for breast cancer. Acta Oncologica. 2014;53(10):1373-9. doi: 10.3109/ 0284186X.2014.934967.
15. Abdemanafi SM, Tavakoli MB, Akhavan A, Abedi I. Evaluation of the lung volume changes in patients with breast cancer based on the received dose in the upper and lower lobes of the lung. J Isfahan Med Sch. 2019;37(514):60-5. doi: 10.1016/j.rpor.2019.09.005.
16.Hernberg M, Virkkunen P, Maasilta P, Keyriläinen J, Blomqvist C, Bergh J, et al. Pulmonary toxicity after radiotherapy in primary breast cancer patients: results from a randomized chemotherapy study. Int J Radiat Oncol Biol Phys. 2002; 52: 128-36. doi: 10.1016/s0360-3016(01)01760-6.
17. Lind PA, Marks LB, Hardenbergh PH, Clough R, Fan M, Hollis D, et al. Technical factors associated with radiation pneumonitis after local +/- regional radiation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 2002;52(1):137-43. doi: 10.1016/s0360-3016(01)01715-1.
18. Fragkandrea I, Kouloulias V, Mavridis P, Zettos A, Betsou S, Georgolopoulou P, et al. Radiation induced pneumonitis following whole breast radiotherapy treatment in early breast cancer patients treated with breast conserving surgery: a single institution study. Hippokratia. 2013;17(3):233-8.
19.Malekzade M, peykani S, amani O. Comparative study of quality of life in women survived with those suffered from breast cancer while under chemotherapy. [In Persian] JHPM. 2017;6(4) :8-14. doi: 10.21859/jhpm-07022.
20. Khoshbin A. Evaluation of pulmonary complications of tangential radiotherapy of breast cancers through pulmonary function tests and the effect of irradiated lung volume on it. Med J Tabriz Uni Med Sciences. 2010;33(1):25-8.
21. Vasiljevic D, Arnold C, Neuman D, Fink K, Popovscaia M, Kvitsaridze I, et al. Occurrence of pneumonitis following radiotherapy of breast cancer - A prospective study. Strahlenther Onkol. 2018;194(6):520-32. doi: 10.1007/s00066-017-1257-z.
22. Cho BC, Hurkmans CW, Damen EM, Zijp LJ, Mijnheer BJ. Intensity modulated versus non-intensity modulated radiotherapy in the treatment of the left breast and upper internal mammary lymph node chain: a comparative planning study. Radiother Oncol. 2002;62(2):127-36. doi: 10.1016/s0167-8140(01) 00472-8.
23. Lund MB, Myhre KI, Melsom H, Johansen B. The effect on pulmonary function of tangential field technique in radiotherapy for carcinoma of the breast. Br J Radiol. 1991;64(762):520-3. doi: 10.1259/0007-1285-64-762-520.
24. Chang JH, Vines E, Bertsch H, Fraker DL, Czerniecki BJ, Rosato EF, et al. The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience. Cancer. 2001;91(7):1231-7. doi: 10.1002/1097-0142(20010401)91:7<1231::aid-cncr1123>3.0.co;2-k.