J Breast Cancer.  2012 Sep;15(3):337-343. 10.4048/jbc.2012.15.3.337.

Radiation Pneumonitis in Breast Cancer Patients Who Received Radiotherapy Using the Partially Wide Tangent Technique after Breast Conserving Surgery

• Chung Y
• Yoon HI
• Kim YB
• Ahn SK
• Keum KC
• Suh CO

• KMID: 2286460
• DOI: http://doi.org/10.4048/jbc.2012.15.3.337

Abstract

PURPOSE
We assessed the risk of radiation pneumonitis (RP) in terms of dosimetric parameters in breast cancer patients, who received radiotherapy using the partially wide tangent technique (PWT), following breast conservation surgery (BCS).
METHODS
We analyzed the data from 100 breast cancer patients who underwent radiotherapy using PWT. The entire breast, supraclavicular lymph node, and internal mammary lymph node (IMN) were irradiated with 50.4 Gy in 28 fractions. RP was scored on a scale of 0 to 5, based on Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity criteria. The dosimetric parameters, used in analysis for the ipsilateral lung, were the mean lung dose (MLD), V5 (percentage of lung volume that received a dose of 5 Gy or more)-V50, and normal tissue complication probability (NTCP).
RESULTS
Of the 100 patients, three suffered from symptomatic RP (symptom grade > or =2), but were relieved by supportive care. The risk of RP was not correlated with the treatment regimen. RP associated mostly with asymptomatic minimal pulmonary radiologic change or mild dry cough developed more frequently in the group with MLD > or =20.5 Gy or NTCP > or =23% than in the group with MLD <20.5 Gy and NTCP <23% (48.6% vs. 25.4%, p=0.018).
CONCLUSION
Dosimetric parameters of MLD and NTCP were correlated with the incidence of RP, but the clinical impact was minimal. We suggest that PWT is a safe technique for the treatment of IMN for BCS patients with low risk of symptomatic RP.

Keyword

Breast neoplasms; Conformal radiotherapy; Lymphatic irradiation; Radiation pneumonitis

MeSH Terms

Breast
Breast Neoplasms
Cough
Humans
Incidence
Lung
Lymph Nodes
Lymphatic Irradiation
Mastectomy, Segmental
Radiation Pneumonitis
Radiotherapy, Conformal

Figure

• 

  Figure 1 Field arrangement of partially wide tangent technique for treating supraclavicular lymph node (SCL), breast, and internal mammary lymph node (IMN). (A) Planning computed tomography image. (B) Beams-eye-view of frontal field for SCL and lateral tangential fields for breast and IMN.

• 

  Figure 2 Scatterplot of the mean ipsilateral lung dose (MLD, Gy) vs. normal tissue complication probability (NTCP, %). Patients with a total grade ≥1 radiation pneumonitis (RP) are plotted as solid circles; the other patients are represented as open circles. The gray region represents those who had MLD <20.5 Gy and NTCP <23%; this region had a lower incidence of RP than the rest of the region (25.4% vs. 48.6%, p=0.018).

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