Document Type : Original Research


1 PhD, Immunology research center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 MSc, Department of Medical Physics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

3 MD, Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

4 PhD, Medical Radiation Sciences Research team, Department of Medical Physics, School of Medicine, Tabriz, Iran


Background: Radiotherapy plays an important role in the treatment of breast cancer. In the process of radiotherapy, the underling lung tissue receives higher doses from treatment field, which led to incidence of radiation pneumonitis.
Objective: The present study aims to evaluate the predictive factors of radiation pneumonitis and related changes in pulmonary function after 3D-conformal radiotherapy of breast cancer.
Material and Methods: In prospective basis study, thirty-two patients with breast cancer who received radiotherapy after surgery, were followed up to 6 months. Respiratory symptoms, lung radiologic changes and pulmonary function were evaluated. Radiation pneumonitis (RP) was graded according to common terminology criteria for adverse events (CTCAE) version 3.0. Dose-volume parameters, which included percentage of lung volume receiving dose of d Gy (V5-V50) and mean lung dose (MLD), were evaluated for RP prediction. Pulmonary function evaluated by spirometry test and changes of FEV1 and FVC parameters.
Results: Eight patients developed RP. Among the dose-volume parameters, V10 was associated to RP incidence. When V10<40% and V10≥40% the incidences of RP were 5.26% and 61.54%, respectively. The FEV1 and FVC had a reduction 3 and 6 months after radiotherapy, while only FEV1 showed significant reduction. The FEV1 had more reduction in the patients who developed RP than patients without RP (15.25±3.81 vs. 9.2±0.93).
Conclusion: Pulmonary function parameters, especially FEV1, significantly decreased at 3 and 6 months after radiotherapy. Since most patients with breast cancer who developed RP did not show obvious clinical symptoms, so spirometry test is beneficial to identify patients with risk of radiation pneumonitis.


  1. Emami RS, Aghajani H, Haghazali M, Nadali F, et al. The most common cancers in Iranian women. Iranian J Publ Health. 2009;38:109-12.
  2. Alizadeh OH, Hoseini M, Mirmalek A, Ahmari H, Arab F, Mohtasham AN. Breast Sarcoma: a review article. Iranian Journal of Surgery. 2014;22:1-11.
  3. Mousavi SM, Montazeri A, Mohagheghi MA, Jarrahi AM, Harirchi I, Najafi M, et al. Breast cancer in Iran: an epidemiological review. Breast J. 2007;13:383-91. doi: 10.1111/j.1524-4741.2007.00446.x. PubMed PMID: 17593043.
  4. Huang EH, Tucker SL, Strom EA, McNeese MD, et al. Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol. 2004;22:4691-9. doi: 10.1200/JCO.2004.11.129. PubMed PMID: 15570071.
  5. Group EBCTC. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet. 2011;378:1707-16.
  6. Madani I, De Ruyck K, Goeminne H, et al. Predicting risk of radiation-induced lung injury. J Thorac Oncol. 2007;2:864-74. doi: 10.1097/JTO.0b013e318145b2c6. PubMed PMID: 17805067.
  7. Mehta V. Radiation pneumonitis and pulmonary fibrosis in non-small-cell lung cancer: pulmonary function, prediction, and prevention. Int J Radiat Oncol Biol Phys. 2005;63:5-24. doi: 10.1016/j.ijrobp.2005.03.047. PubMed PMID: 15963660.
  8. Marks LB, Bentzen SM, Deasy JO, Kong FM, et al. Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys. 2010;76:S70-6. doi: 10.1016/j.ijrobp.2009.06.091. PubMed PMID: 20171521. PubMed PMCID: PMC3576042.
  9. Lind PA, Wennberg B, Gagliardi G, Fornander T. Pulmonary complications following different radiotherapy techniques for breast cancer, and the association to irradiated lung volume and dose. Breast Cancer Res Treat. 2001;68:199-210. doi: 10.1023/a:1012292019599. PubMed PMID: 11727957.
  10. Jin H, Tucker SL, Liu HH, Wei X, Yom SS, Wang S, et al. Dose-volume thresholds and smoking status for the risk of treatment-related pneumonitis in inoperable non-small cell lung cancer treated with definitive radiotherapy. Radiother Oncol. 2009;91:427-32. doi: 10.1016/j.radonc.2008.09.009. PubMed PMID: 18937989. PubMed PMCID: PMC5555233.
  11. Dang J, Li G, Zang S, Zhang S, Yao L. Risk and predictors for early radiation pneumonitis in patients with stage III non-small cell lung cancer treated with concurrent or sequential chemoradiotherapy. Radiat Oncol. 2014;9:172. doi: 10.1186/1748-717X-9-172. PubMed PMID: 25074618. PubMed PMCID: PMC4120001.
  12. Roach 3rd M, Gandara DR, Yuo HS, et al. Radiation pneumonitis following combined modality therapy for lung cancer: analysis of prognostic factors. J Clin Oncol. 1995;13:2606-12. doi: 10.1200/JCO.1995.13.10.2606. PubMed PMID: 7595714.
  13. Tsujino K, Hirota S, Endo M, Obayashi K, et al. Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys. 2003;55:110-5. doi: 10.1016/s0360-3016(02)03807-5. PubMed PMID: 12504042.
  14. Spyropoulou D, Leotsinidis M, Tsiamita M, et al. Pulmonary function testing in women with breast cancer treated with radiotherapy and chemotherapy. In Vivo. 2009;23:867-71. PubMed PMID: 19779125.
  15. Trotti A, Colevas AD, Setser A, et al. CTCAE v3. 0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13:176-81. doi: 10.1016/s1053-4296(03)00031-6.
  16. Wang S, Liao Z, Wei X, Liu HH, et al. Analysis of clinical and dosimetric factors associated with treatment-related pneumonitis (TRP) in patients with non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and three-dimensional conformal radiotherapy (3D-CRT). Int J Radiat Oncol Biol Phys. 2006;66:1399-407. doi: 10.1016/j.ijrobp.2006.07.1337. PubMed PMID: 16997503.
  17. Zhou ZR, Han Q, Liang SX, et al. Dosimetric factors and Lyman normal-tissue complication modelling analysis for predicting radiation-induced lung injury in postoperative breast cancer radiotherapy: a prospective study. Oncotarget. 2017;8:33855-63. doi: 10.18632/oncotarget.12979. PubMed PMID: 27806340. PubMed PMCID: PMC5464917.
  18. Lee TF, Chao PJ, Chang L, et al. Developing Multivariable Normal Tissue Complication Probability Model to Predict the Incidence of Symptomatic Radiation Pneumonitis among Breast Cancer Patients. PLoS One. 2015;10:e0131736. doi: 10.1371/journal.pone.0131736. PubMed PMID: 26147496. PubMed PMCID: PMC4492617.
  19. Shi A, Zhu G, Wu H, Yu R, et al. Analysis of clinical and dosimetric factors associated with severe acute radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent chemotherapy and intensity-modulated radiotherapy. Radiat Oncol. 2010;5:35. doi: 10.1186/1748-717X-5-35. PubMed PMID: 20462424. PubMed PMCID: PMC2883984.
  20. Erven K, Weltens C, Nackaerts K, et al. Changes in pulmonary function up to 10 years after locoregional breast irradiation. Int J Radiat Oncol Biol Phys. 2012;82:701-7. doi: 10.1016/j.ijrobp.2010.12.058. PubMed PMID: 21398052.
  21. Park YH, Kim JS. Predictors of radiation pneumonitis and pulmonary function changes after concurrent chemoradiotherapy of non-small cell lung cancer. Radiat Oncol J. 2013;31:34-40. doi: 10.3857/roj.2013.31.1.34. PubMed PMID: 23620867. PubMed PMCID: PMC3633229.