International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: breastBronchiolitis obliterans organizing pneumonia syndrome in breast-conserving therapy for early breast cancer: Radiation-induced lung toxicity
Introduction
Bronchiolitis obliterans organizing pneumonia (BOOP) is a lung disease which is pathologically characterized by the presence of granulation tissue polyps within respiratory bronchioles and alveolar ducts, and patchy areas of organizing pneumonia (1). Most cases of BOOP are idiopathic, but BOOP-like pathological reactions are also caused by pulmonary infection, drugs, rheumatoid disease, and inhalation of toxic fumes (1). Patients with BOOP have a nonproductive cough, dyspnea, fever, malaise, or some combination of these (1).
In 1995, Crestani et al. and Bayle et al. independently reported BOOP after radiotherapy to the breast 2, 3. They suggested the possibility of a relationship between the occurrence of BOOP and adjuvant radiotherapy to the breast. In 1998, Crestani et al. defined BOOP syndrome as the presence of lung infiltrates outside a radiation field, a finding not associated with radiation pneumonitis (4). Since the incidence of and risk factors for BOOP syndrome remain unclear, we evaluated them in our institution.
Section snippets
Study design
Between January 1996 and December 1998, 157 patients with breast cancer underwent radiotherapy after breast-conservative surgery. In surgery, wide excision including a margin of 2–3 cm macroscopically normal breast tissue around palpable tumors and axillary dissection up to levels I and II were performed. When the tumor was not palpable at surgery, the mammary gland, including the original tumor site and surrounding area, were excised. In radiotherapy, the entire breast was irradiated with 6-MV
Clinical courses of patients with BOOP syndrome
Four women were diagnosed with BOOP syndrome; the complication rate of this syndrome was therefore 2.5% (4/157). The four women were 44, 48, 50, and 67 years old. Three had right breast cancers and one had left breast cancer. They were all nonsmokers. Two of the four women had a history of possibly allergy-related symptoms; one had an episode of exanthema when she took a drug (incident unknown in detail), while the other had itching on her lips when she took an antipyrine agent. Radiation doses
Discussion
One of the most important complications of radiation therapy to the breast is pneumonitis. The concept of radiation-primed BOOP syndrome was proposed by Crestani et al. in 1998 (4). Arbetter et al. also reported this complication as “radiation-induced pneumonitis in the nonirradiated lung” in 1999 (6). Differentiation of common BOOP from classical radiation pneumonitis appears to be easy. Patchy consolidation and ground-glass opacity are frequently observed in both of these diseases 7, 8. In
References (16)
- et al.
Can simulation measurements be used to predict the irradiated lung volume in the tangential fields in patients treated for breast cancer?
Int J Radiat Oncol Biol Phys
(1990) - et al.
Radiation-induced pneumonitis in the “nonirradiated” lung
Mayo Clin Proc
(1999) - et al.
Bronchiolitis obliterans organizing pneumoniaClinical features and differential diagnosis
Chest
(1992) - et al.
Radiation pneumonitis in breast cancer treated with conservative surgery and radiation therapy
Int J Radiat Oncol Biol Phys
(1991) - et al.
Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer
Int J Radiat Oncol Biol Phys
(1992) - Fraser RS, Paré JAP, Fraser RG, Paré PD. Synopsis of disease of the chest. 2nd ed. Philadelphia: WB Saunders; 1994. p....
- et al.
Migratory bronchiolitis obliterans organizing pneumonia after unilateral radiation therapy for breast carcinoma
Eur Respir J
(1995) - et al.
Migratory organizing pneumonitis “primed” by radiation therapy
Eur Respir J
(1995)
Cited by (88)
Systematic Review of Systemic Corticosteroids for Treatment of Organizing Pneumonia
2022, Open Respiratory ArchivesEvolving Role of Novel Quantitative PET Techniques to Detect Radiation-Induced Complications
2020, PET ClinicsCitation Excerpt :The anatomic narrowing of alveolar spaces results in diminishing lung volume, collagen deposition can lead to ventilation-perfusion mismatch and result in worsening of pulmonary function, and vascular subintimal fibrosis and distortion cause capillary dysfunction.30 Also, organizing pneumonia even in areas outside the radiation port, including the contralateral lung, has been reported approximately 3 to 17 months after irradiation.31–34 Although acute and subacute RP usually develops in the weeks to first 6 months following radiation exposure, clinical symptoms of radiation fibrosis develop after 6 to 12 months.
Spontaneous resolution of thoracic radiation therapy-induced organizing pneumonia: A case series
2019, Respiratory Medicine Case ReportsRadiation complications and their management
2018, The Breast: Comprehensive Management of Benign and Malignant Diseases
- ∥
Current affiliation: Second Department of Medicine, Okayama University Medical School, Okayama, Japan.
- ¶
Current affiliation: Division of Hematology and Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.