Analysis of Factors Associated With Radiation-Induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome After Breast-Conserving Therapy

Norihisa Katayama, Shuhei Sato, Kuniaki Katsui, Mitsuhiro Takemoto, Toshihide Tsuda, Atsushi Yoshida, Tsuneharu Morito, Tomio Nakagawa, Akifumi Mizuta, Takahiro Waki, Harutaka Niiya, Susumu Kanazawa

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Abstract

Purpose: To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy. Methods and Materials: A total of 702 women with breast cancer who received radiotherapy after breast-conserving surgery at seven institutions between July 1995 and December 2006 were analyzed. In all patients, the whole breast was irradiated with two tangential photon beams. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months, (2) general and/or respiratory symptoms lasting for ≥2 weeks, (3) radiographs showing lung infiltration outside the radiation port, and (4) no evidence of a specific cause. Results: Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Eleven patients (68.8%) were administered steroids. The duration of steroid administration ranged from 1 week to 3.7 years (median, 1.1 years). Multivariate analysis revealed that age (≥50 years; odds ratio [OR] 8.88; 95% confidence interval [CI] 1.16-67.76; p = 0.04) and concurrent endocrine therapy (OR 3.05; 95% CI 1.09-8.54; p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was ≥50 years and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome. Conclusions: Age (≥50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Physicians should carefully follow patients who received breast-conserving therapy, especially those who are older than 50 years and received concurrent endocrine therapy during radiotherapy.

Original languageEnglish
Pages (from-to)1049-1054
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume73
Issue number4
DOIs
Publication statusPublished - Mar 15 2009

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Cryptogenic Organizing Pneumonia
pneumonia
organizing
breast
Statistical Factor Analysis
therapy
Breast
Radiation
radiation
radiation therapy
steroids
Radiotherapy
Therapeutics
confidence
Odds Ratio
Steroids
Confidence Intervals
intervals
physicians
Segmental Mastectomy

Keywords

  • Breast cancer
  • Breast-conserving surgery
  • Endocrine therapy
  • Radiation-induced BOOP syndrome
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Analysis of Factors Associated With Radiation-Induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome After Breast-Conserving Therapy. / Katayama, Norihisa; Sato, Shuhei; Katsui, Kuniaki; Takemoto, Mitsuhiro; Tsuda, Toshihide; Yoshida, Atsushi; Morito, Tsuneharu; Nakagawa, Tomio; Mizuta, Akifumi; Waki, Takahiro; Niiya, Harutaka; Kanazawa, Susumu.

In: International Journal of Radiation Oncology Biology Physics, Vol. 73, No. 4, 15.03.2009, p. 1049-1054.

Research output: Contribution to journalArticle

Katayama, Norihisa ; Sato, Shuhei ; Katsui, Kuniaki ; Takemoto, Mitsuhiro ; Tsuda, Toshihide ; Yoshida, Atsushi ; Morito, Tsuneharu ; Nakagawa, Tomio ; Mizuta, Akifumi ; Waki, Takahiro ; Niiya, Harutaka ; Kanazawa, Susumu. / Analysis of Factors Associated With Radiation-Induced Bronchiolitis Obliterans Organizing Pneumonia Syndrome After Breast-Conserving Therapy. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 73, No. 4. pp. 1049-1054.
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AU - Tsuda, Toshihide

AU - Yoshida, Atsushi

AU - Morito, Tsuneharu

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AB - Purpose: To evaluate factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome after breast-conserving therapy. Methods and Materials: A total of 702 women with breast cancer who received radiotherapy after breast-conserving surgery at seven institutions between July 1995 and December 2006 were analyzed. In all patients, the whole breast was irradiated with two tangential photon beams. The criteria used for the diagnosis of radiation-induced BOOP syndrome were as follows: (1) radiotherapy to the breast within 12 months, (2) general and/or respiratory symptoms lasting for ≥2 weeks, (3) radiographs showing lung infiltration outside the radiation port, and (4) no evidence of a specific cause. Results: Radiation-induced BOOP syndrome was seen in 16 patients (2.3%). Eleven patients (68.8%) were administered steroids. The duration of steroid administration ranged from 1 week to 3.7 years (median, 1.1 years). Multivariate analysis revealed that age (≥50 years; odds ratio [OR] 8.88; 95% confidence interval [CI] 1.16-67.76; p = 0.04) and concurrent endocrine therapy (OR 3.05; 95% CI 1.09-8.54; p = 0.03) were significantly associated with BOOP syndrome. Of the 161 patients whose age was ≥50 years and who received concurrent endocrine therapy, 10 (6.2%) developed BOOP syndrome. Conclusions: Age (≥50 years) and concurrent endocrine therapy can promote the development of radiation-induced BOOP syndrome after breast-conserving therapy. Physicians should carefully follow patients who received breast-conserving therapy, especially those who are older than 50 years and received concurrent endocrine therapy during radiotherapy.

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