Evaluation of delayed changes in pulmonary perfusion scan and pulmonary function tests after radiotherapy for breast cancer

Document Type : Original Article

Authors

1 Department of Radiotherapy, Faculty of Paramedical Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran

2 Department of Internal Medicine, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran

Abstract

Introduction: The application of radiotherapy after performing surgery plays a vital role in the breast cancer treatment. In the current study, we investigated the effects of the radiotherapy for breast cancer on pulmonary perfusion scan (PPS) and pulmonary function tests (PFTs).
Methods: Fifty patients diagnosed with breast cancer with no history of lung diseases who had received radiotherapy after breast surgery and chemotherapy were selected. Mean lung dose (MLD) and volume percentage of the ipsilateral lung receiving a dose equal to or greater than 20 Gy (V20) were calculated for all patients. Quantitative PPS along with SPECT imaging as well as PFTs were performed on each patient before and 6 to 9 months after radiotherapy. For Data analysis, independent Samples t-Test and Pearson's correlation coefficient were used.
Results: There were 27 and 23 patients with right and left breast cancer, respectively. In both groups, the relative perfusion of the lung on the radiotherapy side decreased by an average of 5%, which was significant (P-value<0.05). Among 27 patients (54%), lung perfusion defects were observed in the SPECT images. No significant changes were observed between the PFTs before and after radiotherapy (P-value>0.05). No significant relationship was investigated between V20 and mean lung dose (MLD) with relative perfusion of the irradiated lung (P-value>0.05).
Conclusion: In this investigation, we demonstrated that quantitative PPS and lung perfusion SPECT were are more reliable than PFTs for evaluating lung following radiotherapy for breast cancer. However, the relative lung perfusion bore no relevancy to V20 and MLD.

Keywords

Main Subjects

References

  1. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, Znaor A, Bray F. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019 Apr 15;144(8):1941-53.
  2. DeSantis C, Ma J, Bryan L, Jemal A. Breast cancer statistics, 2013. CA Cancer J Clin. 2014 Jan-Feb;64(1):52-62.
  3. Nafissi N, Khayamzadeh M, Zeinali Z, Pazooki D, Hosseini M, Akbari ME. Epidemiology and histopathology of breast cancer in Iran versus other Middle Eastern countries. Middle East J Cancer. 2018;9(3):243-51.
  4. Li T, Mello-Thoms C, Brennan PC. Descriptive epidemiology of breast cancer in China: incidence, mortality, survival, and prevalence. Breast Cancer Res Treat. 2016 Oct;159(3):395-406.
  5. Abdulrahman GO Jr, Rahman GA. Epidemiology of breast cancer in Europe and Africa. J Cancer Epidemiol. 2012 May; 2012:915610.
  6. Toriola AT, Colditz GA. Trends in breast cancer incidence and mortality in the United States: implications for prevention. Breast Cancer Res Treat. 2013 Apr;138(3):665-73.
  7. da Costa Vieira RA, Biller G, Uemura G, Ruiz CA, Curado MP. Breast cancer screening in developing countries. Clinics. 2017 Apr;72(4):244-53.
  8. Hennigs A, Riedel F, Gondos A, Sinn P, Schirmacher P, Marmé F, Jäger D, Kauczor HU, Stieber A, Lindel K, Debus J, Golatta M, Schütz F, Sohn C, Heil J, Schneeweiss A. Prognosis of breast cancer molecular subtypes in routine clinical care: A large prospective cohort study. BMC Cancer. 2016 Sep 15;16(1):734.
  9. EBCTCG (Early Breast Cancer Trialists' Collaborative Group); McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, Gray R, Mannu G, Peto R, Whelan T, Wang Y, Wang Z, Darby S. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014 Jun 21;383(9935):2127-35.
  10. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, Vallis KA, White JR, Rousseau P, Fortin A, Pierce LJ, Manchul L, Chafe S, Nolan MC, Craighead P, Bowen J, McCready DR, Pritchard KI, Gelmon K, Murray Y, Chapman JA, Chen BE, Levine MN; MA.20 Study Investigators. Regional Nodal Irradiation in Early-Stage Breast Cancer. N Engl J Med. 2015 Jul 23;373(4):307-16.
  11. Abhay J, Pradeep P, Paliwal R., Paliwal Dipesh V. A study on impact of radiotherapy on functional and radiological changes on irradiated lung in breast cancer patients. Healthline. 2018 Jan;9(1):30-5.
  12. Vasiljevic D, Arnold C, Neuman D, Fink K, Popovscaia M, Kvitsaridze I, Nevinny-Stickel M, Glatzer M, Lukas P, Seppi T. Occurrence of pneumonitis following radiotherapy of breast cancer - A prospective study. Strahlenther Onkol. 2018 Jun;194(6):520-32.
  13. Meattini I, Guenzi M, Fozza A, Vidali C, Rovea P, Meacci F, Livi L. Overview on cardiac, pulmonary and cutaneous toxicity in patients treated with adjuvant radiotherapy for breast cancer. Breast Cancer. 2017 Jan;24(1):52-62.
  14. Huang YJ, Huang TW, Lin FH, Chung CH, Tsao CH, Chien WC. Radiation therapy for invasive breast cancer increases the risk of second primary lung cancer: a nationwide population-based cohort analysis. J Thorac Oncol. 2017 May;12(5):782-90.
  15. Suesada MM, Carvalho HA, Albuquerque ALP, Salge JM, Stuart SR, Takagaki TY. Impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer. J Bras Pneumol. 2018 Nov-Dec;44(6):469-76.
  16. AlSaeed EF, Balaraj FK, Tunio MA. Changes in pulmonary function tests in breast carcinoma patients treated with locoregional post-mastectomy radiotherapy: results of a pilot study. Breast Cancer (Dove Med Press). 2017 May 29;9: 375-81.
  17. Jaén J, Vázquez G, Alonso E, De Las Peñas MD, Díaz L, De Las Heras M, Pérez-Regadera JF. Long-term changes in pulmonary function after incidental lung irradiation for breast cancer: a prospective study with 7-year follow-up. Int J Radiat Oncol Biol Phys. 2012 Dec 1;84(5):e565-70.
  18. Aznar MC, Duane FK, Darby SC, Wang Z, Taylor CW. Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010-2015. Radiother Oncol. 2018 Jan;126(1):148-54.
  19. Deng G, Liang N, Xie J, Luo H, Qiao L, Zhang J, Wang D, Zhang J. Pulmonary toxicity generated from radiotherapeutic treatment of thoracic malignancies. Oncol Lett. 2017 Jul;14(1):501-11.
  20. Giridhar P, Mallick S, Rath GK, Julka PK. Radiation induced lung injury: prediction, assessment, and management. Asian Pac J Cancer Prev. 2015;16(7):2613-7.
  21. Eftekhari M, Kalantari F, Emami-Ardekani A, Amini H, Fard-Esfahani A, Fallahi B, Beiki D, Farzanefar S, Kalantari E, Hasanzadeh-Rad A, Abbasi M. Radiation induced myocardial perfusion abnormalities in patients with left breast cancer: A prospective study with short and long term follow up. Iran J Nucl Med. 2017;25(Suppl 1):21-25.
  22. Karlsen J, Tandstad T, Sowa P, Salvesen Ø, Stenehjem JS, Lundgren S, Reidunsdatter RJ. Pneumonitis and fibrosis after breast cancer radiotherapy: occurrence and treatment-related predictors. Acta Oncol. 2021 Dec;60(12):1651-1658.
  23. Elmas O, Erdemir RU, Bakkal BH. Changes in lung perfusion scintigraphy and pulmonary function tests in irradiated breast cancer patients. J Pak Med Assoc. 2021 Jul;71(7):1736-9.
  24. Jafari A, Mousavizadeh MA, Moghani MM, Arfaee AJ. Pulmonary Function Test Changes Two Months after Breast Radiotherapy. Asian Pac J Cancer Care. 2017; 2 (2), 21-23.
  25. Liss AL, Marsh RB, Kapadia NS, McShan DL, Rogers VE, Balter JM, Moran JM, Brock KK, Schipper MJ, Jagsi R, Griffith KA, Flaherty KR, Frey KA, Pierce LJ. Decreased lung perfusion after breast/chest wall irradiation: quantitative results from a prospective clinical trial. Int J Radiat Oncol Biol Phys. 2017 Feb 1;97(2):296-302.
  26. Muttath G, Erakkotan GK, Jayaraj A, Ayyappan SC, ES AK, Narayanan V, Jones J, Narendran AP, Yahiya N, Suresh AP, Malodan R. Volumetric estimation of lung dose and its association with pneumonitis following radiotherapy in breast cancer patients. Asian Pac J Cancer Care. 2022; 7 (2): 207-11.
  27. Arroyo-Hernández M, Maldonado F, Lozano-Ruiz F, Muñoz-Montaño W, Nuñez-Baez M, Arrieta O. Radiation-induced lung injury: current evidence. BMC Pulm Med. 2021 Jan 6;21(1):9.
  28. Zhang J, Ma J, Zhou S, Hubbs JL, Wong TZ, Folz RJ, Evans ES, Jaszczak RJ, Clough R, Marks LB. Radiation-induced reductions in regional lung perfusion: 0.1-12 years data from a prospective clinical study. Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):425-32.

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