Radiation pneumonitis (RP) and lung fibrosis are two known toxicities that arise from incidental irradiation of adjacent ipsilateral lung in BC. The Axilla (Ax) and internal mammary nodal region (IMN) RT is uncommon due to the toxicities associated with them. The regional fields include the ipsilateral supraclavicular fossa (SCF). It is the standard practice to offer patients adjuvant RT to whole breast or chest wall, with or without loco-regional RT (LRRT), depending on the stage of disease. Postoperative radiotherapy (RT) after the breast conservative surgery (BCT) or mastectomy, have been shown to reduce the rates of local recurrence and death in breast carcinomas (BC). Extra caution is needed in SCF and IMN irradiation as they are likely to influence these dosimetric parameters. Use of other modalities may be considered when Ipsilateral lung V 20Gy > 30% or MLD > 15 Gy. Smoking has a trend towards protective effect against RP. A poorly powered study in IMN group contributed to the negative finding. Dose-volume Histogram (DVH) related dosimetric factors (Volume of lung receiving certain dose, V dose and Mean lung Dose, MLD), supraclavicular fossa (SCF) irradiation and age are significantly associated with RP, but not sequential chemotherapy and concomitant use of Tamoxifen. The overall incidence of Clinical and Radiological RP is 14% and 42% respectively. Meta-analysis for RP incidence estimation and odds ratio calculation were carried out. Major studies in thoracic irradiation were reviewed to identify factors frequently associated with RP.
MethodsĮlectronic databases, reference sections of major oncological textbooks and identified studies were searched for synonyms of breast radiotherapy and radiation pneumonitis (RP). This meta-analysis aims to ascertain the significance of early lung toxicity with 3-Dimensional (3D) conformal irradiation for breast carcinomas and identify the sub-groups of patients with increased risk.
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