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Abstract

PURPOSE:

The aim of this study is to present the incidence of radiation pneumonitis (RP) reported within 6 months after treatment for breast cancer with or without internal mammary node irradiation (IMNI).

METHODS:

In the Korean Radiation Oncology Group (KROG) 08-06 phase III randomized trial, patients who were node-positive after surgery were randomly assigned to receive radiotherapy either with or without IMNI. A total of 747 patients were enrolled, and three-dimensional treatment planning with computed tomography simulation was performed for all patients. Of the 747 patients, 722 underwent chest X-rays before and within 6 months after radiotherapy. These 722 patients underwent evaluation, and RP was diagnosed on the basis of chest radiography findings and clinical symptoms. The relationship between the incidence of RP and clinical/dosimetric parameters was analyzed.

RESULTS:

RP developed in 35 patients (4.8%), including grade 1 RP in 26 patients (3.6%), grade 2 RP in nine patients (1.2%); there was no incidence of grade 3 or higher RP. Grade 2 RP cases were observed in only the IMNI group. The risk of developing RP was influenced by IMNI treatment; pneumonitis occurred in 6.5% of patients (n=23/356) who underwent IMNI and in 3.3% of patients (n=12/366) who did not (p=0.047). The differences in lung dosimetric parameters (mean lung dose, V10-40) were statistically significant between the two groups.

CONCLUSION:

IMNI treatment resulted in increased radiation exposure to the lung and a higher rate of RP, but the incidence and severity of RP was minimal and acceptable. This minor impact on morbidity should be balanced with the impact on survival outcome in future analyses.​ 

Author information

​Choi J1, Kim YB1, Shin KH2, Ahn SJ3, Lee HS4, Park W5, Kim SS6, Kim JH7, Lee KC8, Kim DW9, Suh HS10, Park KR10, Shin HS11, Suh CO1.​

1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.

2Department of Radiation Oncology, Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

3Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.

4Department of Radiation Oncology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.

5Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

6Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

7Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

8Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea.

9Department of Radiation Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

10Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Seoul, Korea.

11Department of Radiation Oncology, CHA Bundang Hospital, CHA University College of Medicine, Seongnam, Korea.