Background
Methods and materials
Patient characteristics
Age(y), median (range)
|
52 (19-93)
|
---|---|
Breast site (right/left/bilateral) | 584/573/19 |
Collagen vascular disease (yes/no) | 2/1174 |
Smoking (yes/no/unknown) | 201/973/2 |
Alcohol (yes/no/unknown) | 439/735/2 |
Allergy (yes/no/unknown) Clinical stage (n = 1195 lesion) | 400/775/1 |
0 | 163 |
I | 477 |
IIA/IIB | 270/145 |
IIIA/IIIB/IIIC | 48/32/49 |
IV | 2 |
ocult | 4 |
Ipsilateral breast tumor recurrence | 5 |
Histologictype (n = 1195lesion) Noninvasive ductal carcinoma | 169 |
Invasive ductal carcinoma | 929 |
Others | 97 |
Treatment strategy for breast cancer
BCT (n = 948)
|
PMRT (n = 228)
| |
---|---|---|
Total dose and fractions*
| ||
50 Gy in 25 fractions | 42 | 169 |
50 Gy in 20 fractions | 100 | 0 |
53.2 Gy in 20 fractions | 114 | 0 |
60 Gy in 30 fractions | 468 | 51 |
66 Gy in 33 fractions | 200 | 4 |
70 Gy in 35 fractions | 0 | 2 |
Others | 43 | 2 |
Boost to the tumor bed (yes/no)*
| 917 (95%)/50 (5%) | 58 (25%)/170 (75%) |
Lung V20 (%), median (range) | 6.2% (0.2-31.8) | 13.7% (2.3-24.7) |
Overall radiation therapy time (days), median (range) | 42 days (21-65) | 36 days (28-66) |
Endocrine therapy (yes/no)
|
796 (68%)/380 (32%)
|
---|---|
Tamoxifen + LHRH agonist | 106 |
Tamoxifen | 289 |
Anastrozole | 351 |
Letrozole | 35 |
Exemestane | 13 |
Others | 2 |
Concurrent endocrine therapy (yes/no) | 765 (96%)/31 (4%) |
Chemotherapy (yes/no) | 607 (52%)/569 (48%) |
Preoperative | 231 |
Postoperative | 342 |
Pre and postoperative | 32 |
unknown | 2 |
Anthracycline + Taxiane-based regimen | 471 |
Anthracycline-based regimen | 119 |
Taxiane-based regimen | 10 |
Others | 7 |
Trastuzumab (yes/no) | 68 (6%)/1108 (94%) |
Definition of radiation-induced BOOP syndrome
Statistical analyses
Results
Patient no.
|
Endocrine therapy
|
CT
|
Lung V20(%)
|
Time after RT (mo)
|
Symptoms
|
Treatment
| |
---|---|---|---|---|---|---|---|
1 | BCT | TAM | - | 7.9 | 7.6 | cough | antitussive, |
LHRH-agonist | antibiotic | ||||||
2 | BCT | TAM | - | 6.0 | 4.0 | cough, pyrexia, | steroid, |
decreased SpO2 | antibiotic | ||||||
3 | BCT | TAM | - | 5.0 | 5.3 | cough, pyrexia, | antitussive, |
fatigue | antibiotic | ||||||
4 | BCT | TAM | - | 8.6 | 5.1 | cough, pyrexia | antitussive, |
antibiotic | |||||||
5 | BCT | TAM | - | 8.1 | 2.3 | cough | antitussive, |
steroid | |||||||
6 | BCT | ANA | - | 4.4 | 5.0 | cough, fatuigue | antibiotic |
7 | BCT | ANA | - | 6.0 | 4.7 | cough | antitussive, |
antibiotic | |||||||
8 | BCT | ANA | - | 5.1 | 3.0 | cough, pyrexia | antitussive |
9 | BCT | ANA | - | 9.0 | 4.5 | cough | antitussive, |
antibiotic | |||||||
10 | BCT | ANA | - | 4.8 | 3.1 | cough, fatigue | antitussive, |
antibiotic | |||||||
11 | BCT | ANA | AC | 6.8 | 8.6 | cough | antitussive |
PAC | |||||||
12 | BCT | - | CAF | 5.6 | 6.0 | cough | antibiotic |
13 | PMRT | TAM | CAF | 17.7 | 3.3 | cough, pyrexia | antitussive, |
PAC | antibiotic | ||||||
14 | PMRT | ANA | CAF | 13.4 | 7.4 | cough | antitussive, |
PAC | antibiotic | ||||||
15 | PMRT | - | CAF | 15.6 | 3.9 | cough, pyrexia | antibiotic |
PAC | |||||||
16 | PMRT | - | CAF | 22.0 | 5.3 | cough, pyrexia, | antitussive |
PAC | fatigue |
ALL (n = 1176)
|
BCT (n = 948)
|
PMRT (n = 228)
| ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Parameter
|
Level
|
n (%)
|
Incidence of BOOP syndrome, n (%)
|
p
|
n (%)
|
Incidence of BOOP syndrome, n (%)
|
p
|
n (%)
|
Incidence of BOOP syndrome, n (%)
|
p
|
Age | <52y* | 559 (48) | 3 (0.5) | 0.023 | 457 (48) | 2 (0.4) | 0.039 | 102 (45) | 1 (1.0) | 0.63 |
>-52y | 617 (52) | 13 (2.1) | 491 (52) | 10 (2.0) | 126 (55) | 3 (2.4) | ||||
OneSide | One side | 1157 (98) | 16 (1.4) | 1.00 | 929 (98) | 12 (1.3) | 1.00 | 228 (100) | 4 (1.8) | - |
Bilateral | 19 (2) | 0 (0.0) | 19 (2) | 0 (0.0) | 0 (0) | 0 (0) | ||||
Allergy | Yes | 400 (34) | 6 (1.5) | 0.79 | 328 (35) | 5 (1.5) | 0.76 | 72 (32) | 1 (1.4) | 1.00 |
No | 775 (66) | 10 (1.3) | 619 (65) | 7 (1.1) | 156 (68) | 3 (1.9) | ||||
Unkonwn | 1 (0) | 0 (0.0) | 1 (0) | 0 (0.0) | 0 (0) | 0 (0.0) | ||||
Smoking | Yes | 201 (17) | 5 (2.5) | 0.17 | 147 (16) | 4 (2.7) | 0.10 | 54 (24) | 1 (1.9) | 1.00 |
No | 973 (83) | 11 (1.1) | 800 (84) | 8 (1.0) | 173 (76) | 3 (1.7) | ||||
Unkonwn | 2 (0) | 0 (0.0) | 1 (0) | 0 (0.0) | 1 (0) | 0 (0.0) | ||||
Chemotherapy | Yes | 607 (52) | 6 (1.0) | 0.32 | 389 (41) | 2 (0.5) | 0.14 | 218 (96) | 4 (1.8) | 1.00 |
No | 569 (48) | 10 (1.8) | 559 (59) | 10 (1.8) | 10 (4) | 0 (0.0) | ||||
ET | Yes | 796 (68) | 13 (1.6) | 0.29 | 635 (67) | 11 (1.7) | 0.12 | 161 (71) | 2 (1.2) | 0.58 |
No | 380 (32) | 3 (0.8) | 313 (33) | 1 (0.3) | 67 (29) | 2 (3.0) | ||||
RT | Yes | 765 (96) | 13 (1.7) | 1.00 | 614 (97) | 11 (1.8) | 1.00 | 151 (94) | 2 (1.3) | 1.00 |
No | 31 (4) | 0 (0.0) | 21 (3) | 0 (0.0) | 10 (6) | 0 (0.0) | ||||
Trastuzumab | Yes | 68 (6) | 2 (2.9) | 0.24 | 35 (4) | 0 (0.0) | 1.00 | 33 (14) | 2 (6.1) | 0.10 |
No | 1108 (94) | 14 (1.3) | 913 (96) | 12 (1.3) | 195 (86) | 2 (1.0) | ||||
Treatment | BCT | 948 (81) | 12 (1.3) | 0.53 | - | - | - | - | - | - |
PMRT | 228 (19) | 4 (1.8) | ||||||||
Boost | Yes | 963 (82) | 13 (1.3) | 1.00 | 902 (95) | 12 (1.3) | 1.00 | 61 (27) | 1 (1.6) | 1.00 |
No | 213 (18) | 3 (1.4) | 46 (5) | 0 (0.0) | 167 (73) | 3 (1.8) | ||||
Irradiation to the regional LNs | Yes | 269 (23) | 4 (1.5) | 0.77 | 58 (6) | 0 (0.0) | 1.00 | 211 (93) | 4 (1.9) | 1.00 |
No | 907 (77) | 12 (1.3) | 890 (94) | 12 (1.3) | 17 (7) | 0 (0.0) | ||||
Lung V20 | 0-4.9% | 280 (24) | 2 (0.7) | 0.19 | 274 (29) | 2 (0.7) | 0.62 | 6 (3) | 0 (0.0) | 0.32 |
5.0-9.9% | 620 (53) | 10 (1.6) | 586 (62) | 10 (1.7) | 34 (15) | 0 (0.0) | ||||
10.0-14.9% | 166 (14) | 1 (0.6) | 62 (7) | 0 (0.0) | 104 (46) | 1 (1.0) | ||||
15.0-19.9% | 93 (8) | 2 (2.2) | 22 (2) | 0 (0.0) | 71 (31) | 2 (2.8) | ||||
20.0-24.9% | 14 (1) | 1 (7.1) | 2 (0) | 0 (0.0) | 12 (5) | 1 (8.3) | ||||
25.0-29.9% | 0 (0) | 0 (0.0) | 0 (0) | 0 (0.0) | 0 (0) | 0 (0.0) | ||||
30.0-34.9% | 1 (0) | 0 (0.0) | 1 (0) | 0 (0.0) | 0 (0) | 0 (0.0) | ||||
Unkonwn | 2 (0) | 0 (0.0) | 1 (0) | 0 (0.0) | 1 (0) | 0 (0.0) |
ALL
|
BCT
| ||||
---|---|---|---|---|---|
Parameter
|
Level
|
OR (95% CI)
|
p
|
OR (95% CI)
|
p
|
Age | 10 y increased | 1.58 (1.01, 2.48) | 0.044 | 1.54 (0.92, 2.57) | 0.098 |
Smoking | Yes/No | 3.09 (1.01, 9.48) | 0.049 | 4.12 (1.12, 15.11) | 0.033 |
ET | Yes/No | 2.09 (0.59, 7.44) | 0.25 | 5.50 (0.70, 43.29) | 0.11 |
Chemotherapy | Yes/No | 0.56 (0.20, 1.60) | 0.28 | 0.28 (0.06, 1.32) | 0.11 |
Discussion
Authors
|
Year
|
Investigation
|
Materials
|
Number of patient
|
Incidence (%)
|
Related factor
|
---|---|---|---|---|---|---|
Takigawaetal [4] | 2000 | single institute | BCT | 157 | 2.5 | Immunologic reaction |
Miwaetal [5] | 2004 | single institute | BCT | 206 | 2.4 | not evaluated |
Ogoetal [6] | 2008 | multi-institute | BCT | 2056 | 1.8 | no factor was reported |
Katayamaetal [7] | 2009 | multi-institute | BCT | 702 | 2.3 | age >50, concurrent |
Kuboetal [8] | 2009 | multi-institute | BCT | 413 | 2.9 | endocrine therapy irradiated lung volume |
Ogoetal [9] | 2010 | single institute | BCT | 616 | 1.9 | no factor was reported |
Oieetal [10] | 2013 | single institute | BCT | 428 | 1.2 | radiation pneumonitis |
Thisstudy | 2014 | single institute | BCT and PMRT | 1176 | 1.4 | older age |