Dasatinib-Related Pulmonary Toxicity / Toxicidad pulmonar por dasatinib

ABSTRACT 70-year-old male patient with chronic myeloid leukemia receiving treatment with dasatinib develops respiratory failure associated with pulmonary toxicity related to such drug.

RESUMEN Paciente de sexo masculino, 70 años, con leucemia mieloide crónica en tratamiento con dasatinib, desarrolla insuficiencia respiratoria asociada a toxicidad pulmonar por dicho fármaco.

Toxicidad pulmonar por dasatinib / Dasatinib-Related Pulmonary Toxicity

Paciente de sexo masculino, 70 años, con leucemia mieloide crónica en tratamiento con dasatinib, desarrolla insuficiencia respiratoria asociada a toxicidad pulmonar por dicho fármaco.

70-year-old male patient with chronic myeloid leukemia receiving treatment with da satinib develops respiratory failure associated with pulmonary toxicity related to such drug.

Ginseng ameliorates pulmonary toxicity induced by silicon dioxide nanoparticles in rats

Objective: To investigate the protective and therapeutic role of ginseng against silicon dioxide nanoparticles (SiO

Cadmium (Cd) and Chlorpyrifos (CPF) Induced Pulmonary Toxicity in Wistar Rats

The present study was aimed to know the pulmonary toxicity by individual toxicities of cadmium, chlorpyrifos and their combination in albino wistar rats. The experiment was carried out for 28 days. Group 1 - Control. Group 2 - Cadmium chloride (Cd) @ 22.5 mg/ kg b.wt /per oral / day. Group 3 - Chlorpyrifos (CPF) @ 25 mg/ kg b.wt /per oral / day. Group 4 - Cadmium chloride (Cd) @22.5 mg + Chlorpyrifos (CPF) @ 25 mg/ kg b.wt /per oral / day. Lungs showed mild to moderate congestion in groups 2 and 3 and moderate to severe in group 4 on 15th and 29th day of the experiment. Lung sections of control rats showed normal architecture. Lung sections of group 2 rats on 15th day showed hemorrhages in the interstitium spaces with infiltration of lymphocytes, On 29th day, mild hyperplasia and desquamated bronchial epithelial cells, peri bronchial and peri vascular lymphoid aggregates were noticed. The sections of lung on 15th day of group 3 rats showed exudate and desquamated epithelial cells in the lumen of secondary bronchiole , on 29th day, emphysematous alveoli with loss of architecture of alveolar epithelium, interstitial edema with infiltration of lymphocytes, mild hyperplasia of bronchial epithelial cells were also noticed. In group 4 rats, similar lesions as described in groups 2 and 3 were observed with severe intensity on 15th and on 29th day of the experiment. In combined toxicity group, the severity of lesions were more thus suggesting synergistic effects of these components.

Toxicidad pulmonar aguda por amiodarona con dosis baja de impregnación: reporte de caso / Acute amiodarone pulmonary toxicity with low impregnation dose: case report

Se sabe que la amiodarona, un potente antiarrítmico, causa toxicidad pulmonar. La neumonitis intersticial crónica es la presentación más común. Sin embargo, la toxicidad pulmonar aguda es rara y provoca una mayor mortalidad. Se presenta un paciente de 61 años con fibrilación auricular persistente que, tras tratamiento por un mes con amiodarona vía oral a dosis baja de impregnación de 400 miligramos al día, desarrolló toxicidad pulmonar aguda secundaria al antiarrítmico confirmada por radiografía y tomografía. Su caso tuvo resolución después de la suspensión del fármaco y tratamiento con esteroides.

Amiodarone, considered a potent antiarrhythmic, is known to cause pulmonary toxicity. Chronic interstitial pneumonitis is the most common presentation. However, acute pulmonary toxicity is rare and has a higher case fatality rate. We present a 61-year-old patient with persistent atrial fibrillation who, after a one-month treatment with oral amiodarone at a low dose impregnation of 400 mg/day, develops acute pulmonary toxicity, with radiographic and tomographic resolution after antiarrhythmic suspension and steroid treatment.

Efeitos da vareniclina no tecido pulmonar em modelo animal / Effects of varenicline on lung tissue in the animal model

RESUMO Objetivo O objetivo deste estudo foi investigar os efeitos agudos e crônicos da vareniclina no tecido pulmonar em um estudo experimental. Métodos Um total de 34 ratos foi alocado aleatoriamente em grupos de estudo (vareniclina) e controle. Assim, os ratos foram divididos em dois grupos: (i) grupo controle e (ii) grupo vareniclina. A seguir, os ratos de cada grupo foram, por sua vez, subdivididos igualmente em agudos (C1; V1) e crônicos (C2; V2), e todos os ratos dos grupos agudos e crônicos foram sacrificados sob anestesia: no 45.º dia, para o grupo agudo [C1 (n=5) e V1 (n=12)], e no 90.º dia, para o grupo crônico [C2 (n=5) e V2 (n=12)], respectivamente. Em seguida, foram realizadas análises bioquímicas e histopatológicas. Resultados Trinta e quatro ratos completaram o estudo. Destes ratos, 24 estavam no grupo vareniclina e 10 no grupo controle. Na exposição crônica à vareniclina, os níveis de oxidante composto por malondialdeído (MDA) e mieloperoxidase (MPO) aumentaram, e os níveis de superóxido dismutase (SOD), catalase (CAT), glutationa (GSH) e glutationa peroxidase (GPx), nomeados como antioxidantes, diminuiram significativamente quando comparados com o grupo controle. Os níveis de MDA e MPO também foram significativamente mais elevados e os níveis de SOD, CAT, GPx e GSH foram significativamente mais baixos no grupo vareniclina crônico, quando comparado ao grupo vareniclina agudo. Estes achados também foram confirmados por observações histopatológicas. Conclusões Este é o primeiro estudo que avaliou os efeitos pulmonares da vareniclina experimentalmente em um modelo animal. Observamos que o tratamento crônico da vareniclina causa inflamação e lesão pulmonar.

ABSTRACT Objective This study aimed to investigate acute and chronic effects of varenicline on lung tissue in an experimental study. Methods A total of 34 rats were randomly allocated into study (varenicline) and control groups. The rats were divided into two groups (i) control group, (ii) varenicline group. Then, the rats in the each group were sub-divided equally in turn as acute (C1; V1) and chronic (C2; V2) ; all rats of acute and chronic groups were sacrificed under the anesthesia on the 45th day for acute group [C1 (n=5) and V1 (n=12)] and the 90th day for chronic group [C2 (n=5) and V2 (n=12)], respectively. Thus, biochemical and histopathological analysis were carried out. Results Thirty four rats completed the study, 24 were in varenicline group and 10 were in control group. In chronic exposure to varenicline, oxidant levels comprising of malondialdehyde (MDA), and myeloperoxidase (MPO) increased and superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and glutathione peroxidase (GPx) levels, named as antioxidants, decreased significantly when compared to the control group. MDA and MPO levels were also significantly higher and SOD, CAT, GPx, GSH levels were also significantly lower in chronic varenicline group when compared to acute varenicline group. These findings were also supported by histopathological observations. Conclusion This is the first study, which evaluated pulmonary effects of varenicline experimentally on an animal model. It was observed that chronic varenicline treatments cause inflammation and lung cell injury.

Effects of Mesenchymal Stem Cells and Their Derived Microvesicles on Pulmonary Toxicity Induced by Petrol Exhaust Nanoparticle; Histological and Immuno-Histochemical Study

Background: Diesel vehicles exhaust contains toxic nanoparticles that drastically affect lung tissue due to their direct cytotoxic effects, induction of oxidative stress, inflammatory signaling pathways and DNA damage. Mesenchymal stem cells (MSCs) exhibit anti-inflammatory effects and efficient regenerative capacity in chronic lung diseases. Objectives: Evaluation of the effects of MSCs and MSCs-derived micro vesicles (MSCs-MVs) on pulmonary toxicity induced by diesel exhaust nanoparticles (DENPs). Materials and Methods: Sixty male rats were equally divided into: Group I (Control rats), Group II (DENPs group) received repeated doses of DENPs (180μg/rat) intratracheally every other day for 6 days, Group III (MSCs group) received MSCs intravenously (3×106 cells) after the last dose of DENPs and Group IV (MSCs-MVs group) received MSCs-MVs (0.5 mg/mL) intravenously after the last dose of DENPs. Lung tissue were subjected to histological and immunohistochemical assessment. Inflammatory cytokines and bronchoalveolar lavage fluid (BALF) contents of inflammatory cells, albumin, LDH and total proteins were evaluated. Results: Histological picture of lung tissue in DENPs group showed numerous collapsed alveoli, thick interalveolar septa and marked cellular infiltration. Elastic fibers were markedly decreased by DENPs. Increased optical density of NF-κB/p65 immunoreactivity. Bronchoalveolar lavage fluid showed significant elevation of inflammatory cytokines (TNF-a, IL-6), polymorphonuclear leukocytes (PMN), neutrophils, macrophages, LDH, total proteins and albumin. Treatment with either MSCs or MSCs-MVs led to a significant amelioration of all of the aforementioned studied parameters. Conclusion: MSCs-MVs and MSCs showed significant therapeutic effects against DENPs damaging effects on the lung tissues via their regenerative capacity and anti-inflammatory effects.

Cáncer de mama: técnica de posición mama prona en pacientes con estadios I y II / Breast cancer: breast prone position technique in patients with stage I and II

En el tratamiento del cáncer de mama, son varias las técnicas que se describen en materia de radioterapia oncológica. Objetivo: La investigación pretendió analizar la técnica de mama prona en cuanto a beneficio para las pacientes con cáncer de mama estadios I y II en el servicio de radioterapia oncológica y medicina nuclear del Hospital Universitario de Caracas. Métodos: Se trata de un estudio descriptivo, prospectivo y comparativo con una muestra conformada por 20 pacientes. Los casos se registraron en el instrumento de recolección de datos del paciente. Para este estudio se emplearon las técnicas de la estadística descriptiva. Resultados: La frecuencia de pacientes atendidas tuvo un aumento interanual entre 35 % y 40 %. El 60 % de las pacientes presentaron estadio IB, 25 % IA y 15 % con estadio IIA. Conclusión: La posición prona es una técnica reproducible que beneficia principalmente a las pacientes con mamas grandes y/o péndulas, permite protección del corazón excluyendo el haz del rayo a nivel cardiaco(AU)

In the treatment of breast cancer, there are several techniques that are described in terms of radiation therapy. Objetive: The research aimed to analyze the prone breast technique in terms of benefit for patients with stage I and II breast cancer in the oncological radiotherapy and nuclear medicine service of the University Hospital of Caracas. Methods: This is a descriptive, prospective and comparative study with a sample consisting of 20 patients. The cases were recorded in the patient data collection instrument. For this study, the techniques of descriptive statistics were used. Results: the frequency of patients attended had an interannual increase between 35 % and 40 %. 60 % of the patients presented stage IB, 25 % IA and 15 % with stage IIA. Conclusion: The prone position is a reproducible technique that mainly benefits the patients with large breasts and / or pendulums, allows protection of the heart excluding the beam of the ray at cardiac level(AU)

Pulmonary toxicity related to EGFR-TKI monotherapy or its combination with radia-tion as treatment for non-small cell lung cancer / 中国肿瘤临床

Monotherapy of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) serves as the first-line treatment for non-small cell lung cancer (NSCLC) patients with EGFR mutation. Pre-clinical studies confirmed that TKIs can increase radiation sensitiv-ity. Clinical studies confirmed that EGFR-TKI combined with radiotherapy may improve survival of patients and can be used as alterna-tive to chemoradiotherapy. Pulmonary toxicity induced by EGFR-TKIs monotherapy features low incidence rate but high mortality rate, and the incidence rate raries when TKIs is combined with radiotherapy. In this review, we summarise related literature on pulmonary toxicity in EGFR-TKI monotherapy or its combination with radiotherapy for advanced NSCLC. This study can serve as reference for safe-ty of this combined therapy.

Literature Analysis of 20 Cases of Amiodarone-induced Pulmonary Toxicity / 中国药房

OBJECTIVE:To summarize general regularity and characteristics of amiodarone-induced pulmonary toxicity,and to provide reference for rational use of amiodarone and avoiding the occurrence of ADR. METHODS:Retrieved from CNKI,VIP and Wanfang database,individual case report literatures about amiodarone-induced pulmonary toxicity were collected during 1990-2016. The included cases were analyzed statistically. RESULTS:A total of 19 related literatures were collected,involving 20 cases of amiodarone-induced pulmonary toxicity. Among them,the patients older than 60 years old accounted for 75.0% with ratio of male to female 3:1. 75.0% patients had used medicine more than 1 month when pulmonary toxicity occurred. The dose of amiod-arone in 17 patients ranged 200-400 mg/d. Six patients died,accounting for 30.0%. CONCLUSIONS:Pulmonary toxicity induced by amiodarone may be related to patients'gender,age,dose and medication time. The mortality of it is in relative high level. Med-ical staff should pay attention to it,regularly monitor and process it timely.

Pulmonary Toxicity in Rats Caused by Exposure to Intratracheal Instillation of SiO2 Nanoparticles / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The effect of the silica nanoparticles (SNs) on lungs injury in rats was investigated to evaluate the toxicity and possible mechanisms for SNs.</p><p><b>METHODS</b>Male Wistar rats were instilled intratracheally with 1 mL of saline containing 6.25, 12.5, and 25.0 mg of SNs or 25.0 mg of microscale SiO2 particles suspensions for 30 d, were then sacrificed. Histopathological and ultrastructural change in lungs, and chemical components in the urine excretions were investigated by light microscope, TEM and EDS. MDA, NO and hydroxyproline (Hyp) in lung homogenates were quantified by spectrophotometry. Contents of TNF-α, TGF-β1, IL-1β, and MMP-2 in lung tissue were determined by immunohistochemistry staining.</p><p><b>RESULTS</b>There is massive excretion of Si substance in urine. The SNs lead pulmonary lesions of rise in lung/body coefficients, lung inflammation, damaged alveoli, granuloma nodules formation, and collagen metabolized perturbation, and lung tissue damage is milder than those of microscale SiO2 particles. The SNs also cause increase lipid peroxidation and high expression of cytokines.</p><p><b>CONCLUSION</b>The SNs result into pulmonary fibrosis by means of increase lipid peroxidation and high expression of cytokines. Milder effect of the SNs on pulmonary fibrosis comparing to microscale SiO2 particles is contributed to its elimination from urine due to their ultrafine particle size.</p>

Pulmonary toxicity of single-wall carbon nanotubes and its oxidative stress mechanism / 第二军医大学学报

Objective To systematically study the pulmonary toxicity of single-wall carbon nanotubes (SWCNTs) and to explore the related cytotoxicity mechanism, so as to provide a theoretical basis for the safe productionandapplication of SWCNTs. Methods A549 cells were cultured in the media containing 0, 25, 50, 100, 150, and 200 μg/mL SWCNTs for 24 h, and then the cell viability and degree of cell membrane damage were assessed by CCK-8 and lactate dehydrogenase (LDH) release assay kit, respectively; the ultrastructural alteration of A549 cells was detected by transmission electron microscope (TEM). The oxidative stress response was evaluated by assessing reactive oxygen species (ROS), glutathione (GSH) and superoxide dismutase (SOD). The rats were exposed to SWCNTs by intratracheal inhalation, and then the animals were sacrificed 3 days later and the pathological sections of lung tissue were examined. Results SWCNTs showed considerable toxicity to A549 cells, decreasing cell viability, causing severe damage of cell membrane and ultrastructure, increasing the intracellular ROS level, and decreasing GSH content and SOD activity. It was found that oxidative stress is the main mechanism of SWCNTs toxicity on A549 cells. In vivo toxicity results showed that SWCNTs accumulated in the lung tissue # causing alveolar wall edema. Conclusion In vitro and in vivo toxicity results have found that SWCNTs possess a significant pulmonary toxicity # with its main toxicity mechanismbeing oxidative stress.

The diagnostic utility of chest computed tomography scoring for the assessment of amiodarone-induced pulmonary toxicity

BACKGROUND/AIMS: Amiodarone is one of the most widely used antiarrhythmic agents; however, amiodarone-induced pulmonary toxicity (APT) can be irreversible and sometimes fatal. The aim of this study was to evaluate the feasibility of chest computed tomography (CT) as a diagnostic tool for APT and to assess the utility of the CT APT score as an index for predicting the severity of APT. METHODS: Patients underwent amiodarone treatment for various reasons, most often atrial fibrillation, for more than 2 years, and those that received a cumulative dose > 100 g were enrolled. A total of 34 patients who underwent chest CT between December 2011 and June 2012 were enrolled, whether or not they had clinical symptoms. The APT CT score was defined as the number of involved regions in the lung, which was divided into 18 regions (right and left, upper, middle, and lower, and central, middle, and peripheral). The CT findings were evaluated according to the total dose and duration of amiodarone treatment and the results of a pulmonary function test. Clinical symptoms and outcomes were also evaluated according to APT CT scores. RESULTS: Seven patients had positive APT CT scores (interstitial fibrosis in five, organizing pneumonia in one, and mixed interstitial fibrosis and organizing pneumonia in one), and these patients exhibited significantly lower diffusion capacity for carbon monoxide in the lungs compared with patients without an increased APT CT score (70.2% +/- 6.9% vs. 89.7% +/- 19.4%; p = 0.011). Three of the seven patients experienced overt APT that required hospital admission. CONCLUSIONS: Chest CT is a useful diagnostic tool for APT, and the APT CT score might be a useful index for assessing the severity of APT.

Amiodarone Induced Multiorgan Toxicity in a Patient of Hypertrophic Cardiomyopathy With Atrial Fibrillation

Amiodarone is an antiarrhythmic drug known to have adverse effects on multiple organs. Most studies have reported the side effects of the drug, which may result from rapid administrations or from long-term, high dosage administrations. However, toxicity issues have also been reported from patients administered with low doses of the drug for a long period of time. Here we report a case of an 82-year-old female who had shown symptoms and signs of pulmonary, hepatic, and neurotoxicity after taking amiodarone for 14 months in order to treat her atrial fibrillation without regular outpatient follow-up. We highlight the importance of the recommended evaluations, including lung, liver, and thyroid functions, as well as the neurological examinations in patients treated with amiodarone for a long period of time during regular follow-up.

Acute Pulmonary Toxicity and Body Distribution of Inhaled Metallic Silver Nanoparticles

The purpose of this study was to determine the acute pulmonary toxicity of metallic silver nanoparticles (MSNPs, 20.30 nm in diameter). Acute pulmonary toxicity and body distribution of inhaled MSNPs in mice were evaluated using a nose-only exposure chamber (NOEC) system. Bronchoalveolar lavage (BAL) fluid analysis, Western blotting, histopathological changes, and silver burdens in various organs were determined in mice. Mice were exposed to MSNPs for 6 hrs. The mean concentration, total surface area, volume and mass concentrations in the NOEC were maintained at 1.93 x 10(7) particles/cm3, 1.09 x 10(10) nm2/cm3, 2.72 x 10(11) nm3/cm3, and 2854.62 microg/m3, respectively. Inhalation of MSPNs caused mild pulmonary toxicity with distribution of silver in various organs but the silver burdens decreased rapidly at 24-hrs post-exposure in the lung. Furthermore, inhaled MSNPs induced activation of mitogen-activated protein kinase (MAPK) signaling in the lung. In summary, single inhaled MSNPs caused mild pulmonary toxicity, which was associated with activated MAPK signaling. Taken together, our results suggest that the inhalation toxicity of MSNPs should be carefully considered at the molecular level.

Amiodarone-induced Pulmonary Toxicity within a Short Period of the Initiation of Amiodarone Therapy: A Case Report / 대한구급학회지

Amiodarone is one of the most commonly prescribed antiarrhythmic drug for almost all atrial or ventricular arrythmias. Amiodarone-induced pulmonary toxicity (APT) was first described in 1980 and has potentially serious side effects that are believed to develop in 5% of patients. In general, APT occurs only when high amiodarone doses are used for a long time. However, during short-term therapy of amiodarone, APT is rarely reported. In this report, we describe a case of amiodarone-induced pulmonary toxicity after a short course of amiodarone therapy for atrial fibrillation.

Acute accidental exposure to chlorine gas: Clinical presentation, pulmonary functions and outcomes.

Background. To study the clinical presentation, pulmonary functions and outcomes in subjects who were accidentally exposed to chlorine gas. Methods. Prospective observational study of 64 patients who sustained acute accidental exposure to chlorine gas during a leak in the chlorination system of the public bathing pool of a temple. Results. The major presenting symptoms and signs included acute dyspnoea (100%), chest discomfort (100%), cough (97%), eye irritation (88%), giddiness (72%), vomiting (46%), and heaviness in the head (44%); tachycardia (100%), tachypnoea (96%) and polyphonic wheezing (28%). All patients were managed in the emergency room with humidified oxygen inhalation and beta-2 agonist nebulisation and 52 were discharged within six hours. Twelve patients were severely affected and required hospitalisation; three of them were admitted into the intensive care unit. Three patients developed pulmonary oedema six to eight hours following admission. Pulmonary function testing (n=12) at presentation revealed obstructive defect in eight and mixed obstructive-cum-restrictive defect in four patients. The mean duration of hospital stay was 5.1±2.1 days. None of the patients died. Reactive airway dysfunction syndrome (RADS) was observed in three of the 12 hospitalised patients, who complained of manifested persistent cough that lasted for three months period following discharge. Serial pulmonary functions recovered to normal range by the end of the six months in all patients and remained so at one-year follow-up. Conclusion. Acute exposure to chlorine gas is an uncommon, but important public health hazard and can cause RADS, acute lung injury and pulmonary function abnormalities , which are reversible on prompt and appropriate management.

Neumonía intersticial asociada a sirolimus en un paciente con trasplante hepático / Sirolimus-associated interstitial pneumonitis in a liver transplant recipient

Con la utilización de sirolimus en pacientes trasplantados, se han reportado casos de neumonitis intersticial, bronquiolitis obliterante y neumonía organizada. Nosotros describimos un caso de toxicidad pulmonar asociada al uso de sirolimus en un paciente de 59 años con trasplante hepático, revisamos los reportes de caso donde se describía toxicidad pulmonar asociada al uso de sirolimus en pacientes con trasplante hepático, con el objetivo de encontrar similitudes en factores de riesgo, manifestaciones clínicas y desenlaces. De los cinco casos reportados desde enero de 2000, incluyendo el presente, encontramos que las manifestaciones clínicas fueron similares presentándose fiebre, disnea, fatiga, tos y hemoptisis. Con la suspensión del medicamento, los pacientes resolvieron sus signos, síntomas y hallazgos imagenológicos. La toxicidad pulmonar asociada a sirolimus debe ser considerada como diagnóstico diferencial de aquellos pacientes con trasplante hepático que reciban este medicamento y presenten manifestaciones respiratorias, pues la suspensión del medicamento lleva a la resolución del cuadro.

Sirolimus is an immunosuppressive drug that has been used during the past few years. Sirolimus is indicated in rescue therapies and to reduce the secondary toxic effects of calcineurin inhibitors. This drug has been associated with infrequent but severe pulmonary toxicity. Cases of interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia, and alveolar proteinosis have been described. We describe a case of pulmonary toxicity associated with the use of sirolimus in a 59-yr-old liver transplant recipient. We also review all reported cases of sirolimus-associated lung toxicity among liver transplantation recipients, with the intention of understanding the risk factors, the clinical picture and the outcomes of this complication. Five cases have been reported since January 2000, including the present case. Clinical presentation is similar, with fever, dyspnea, fatigue, cough, and hemoptysis. Discontinuation of the drug led to resolution of clinical and radiographic findings. Sirolimus-induced pulmonary toxicity is a serious condition and should be considered in the differential diagnosis of liver recipients presenting with respiratory findings. Discontinuation of the drug is associated with resolution of the pulmonary compromise.

A Case Report of Amiodarone-induced Multiple Toxicity after a Long Course of a Low Dose Therapy

Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. But it has a wide range of adverse effects, including pulmonary toxicity, thyroid dysfunction, liver toxicity, gastrointestinal events, corneal deposits, peripheral neuropathy and so on. Patients treated with amiodarone should be followed regularly to assess ongoing need for amiodarone, efficacy of the drug, appropriateness of dosage, adverse effects, and potential drug interactions. We experienced a case of severe weight loss due to amiodarone-induced multiple toxicity after a long course of a low dose therapy. So we report this unusual case with literature review.

Radiation-induced Pulmonary Toxicity following Adjuvant Radiotherapy for Breast Cancer / 대한방사선종양학회지

PURPOSE: To evaluate the incidences and potential predictive factors for symptomatic radiation pneumonitis (SRP) and radiographic pulmonary toxicity (RPT) following adjuvant radiotherapy (RT) for patients with breast cancer. A particular focus was made to correlate RPT with the dose volume histogram (DVH) parameters based on three-dimensional RT planning (3D-RTP) data. MATERIALS AND METHODS: From September 2003 through February 2006, 171 patients with breast cancer were treated with adjuvant RT following breast surgery. A radiation dose of 50.4 Gy was delivered with tangential photon fields on the whole breast or chest wall. A single anterior oblique photon field for supraclavicular (SCL) nodes was added if indicated. Serial follow-up chest radiographs were reviewed by a chest radiologist. Radiation Therapy Oncology Group (RTOG) toxicity criteria were used for grading SRP and a modified World Health Organization (WHO) grading system was used to evaluate RPT. The overall percentage of the ipsilateral lung volume that received > or =15 Gy (V15), 20 Gy (V20), and 30 Gy (V30) and the mean lung dose (MLD) were calculated. We divided the ipsilateral lung into two territories, and defined separate DVH parameters, i.e., V15 TNGT, V20 TNGT, V30 TNGT, MLD TNGT, and V15 SCL, V20 SCL, V 30SCL, MLD SCL to assess the relationship between these parameters and RPT. RESULTS: Four patients (2.1%) developed SRP (three with grade 3 and one with grade 2, respectively). There was no significant association of SRP with clinical parameters such as, age, pre-existing lung disease, smoking, chemotherapy, hormonal therapy and regional RT. When 137 patients treated with 3D-RTP were evaluated, 13.9% developed RPT in the tangent (TNGT) territory and 49.2% of 59 patients with regional RT developed RPT in the SCL territory. Regional RT (p<0.001) and age (p=0.039) was significantly correlated with RPT. All DVH parameters except for V15 TNGT showed a significant correlation with RPT (p<0.05). MLDTNGT was a better predictor for RPT for the TNGT territory than V15 SCL for the SCL territory. CONCLUSION: The incidence of SRP was acceptable with the RT technique that was used. Age and regional RT were significant factors to predict RPT. The DVH parameter was good predictor for RPT for the SCL territory while MLD TNGT was a better predictor for RPT for the TNGT territory.