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Radiation pneumonitis in relation to pulmonary function, dosimetric factors, TGFβ1 expression, and quality of life in breast cancer patients receiving post-operative radiotherapy: a prospective 6-month follow-up study

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Abstract

Purpose

To investigate development of radiation pneumonitis (RP) in relation to pulmonary function, dosimetric factors, and transforming growth factor beta-1 (TGFβ1) expression in irradiated breast cancer patients.

Methods

A total of 49 breast cancer patients who received post-operative radiotherapy (RT) were evaluated in terms of pulmonary function tests (PFTs), quality of life (QoL), development of RP, dosimetric factors, cytokine levels, and lung high-resolution computed tomography (HRCT) before and after RT. ROC analysis was performed for performance of dosimetric factors in predicting RP, while frequencies of single nucleotide polymorphisms (SNPs) genotyped for TGFβ1 (rs11466345 and rs1800470) were also evaluated.

Results

All cases with RP (10.2%) recovered clinically at the end of third post-RT month. PFT and HRCT parameters were similar before and after RT overall, as well as by RP and the radiation field subgroups. ROC analysis revealed the significant role of the ipsilateral V5 (cutoff value of 45.9%, p = 0.039), V10 (29.4%, p = 0.015), V20 (23%, p = 0.017), and MLD (1200 cGy, p = 0.030) in predicting RP. Higher post-RT TGFβ1 levels (p = 0.037) were noted overall and in patients with RP. Patient and control groups were similar in terms of frequencies of SNPs genotyped for TGFβ1 (rs11466345 and rs1800470). EORTC QLQ-C30 and QLQ-BR-23 scores were similar in patients with vs. without RP.

Conclusion

Our findings revealed significant role of dosimetric factors including MLD, V20 as well as the low dose-volume metrics in predicting the risk of RP among breast cancer patients who received post-operative RT. Implementation of RT, extent of radiation field or the presence of RP had no significant impact on PFTs.

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Data availability

Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

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Funding

This study was supported by Marmara University Scientific Research Projects Committee (Project Number: SAG-B-050614-0218).

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Authors and Affiliations

  1. Department of Radiation Oncology, Marmara University School of Medicine, Fevzi Cakmak Mah. Muhsin Yazıcıoglu Cd. No: 6 34899 Pendik, Istanbul, Turkey

    Zerrin Ozgen & Beste Melek Atasoy

  2. Department of Biophysics, Marmara University School of Medicine, Istanbul, Turkey

    Oya Orun & Pinar Mega Tiber

  3. Department of Medical Education, Marmara University School of Medicine, Istanbul, Turkey

    Esra Akdeniz

  4. Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey

    Canan Cimsit

  5. Department of Chest Diseases and Intensive Care, Marmara University School of Medicine, Istanbul, Turkey

    Emel Eryuksel & Sait Karakurt

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  1. Zerrin Ozgen
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Correspondence to Zerrin Ozgen.

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Ethical approval

This study was conducted in accordance with the ethical principles stated in the “Declaration of Helsinki” and approved by the Marmara University Faculty of Medicine Ethics Committee (Date of Approval: 28/06/2013, Reference number/Protocol No: 2013-0212).

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Written informed consent was obtained from each subject following a detailed explanation of the objectives and protocol of the study.

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Ozgen, Z., Orun, O., Atasoy, B.M. et al. Radiation pneumonitis in relation to pulmonary function, dosimetric factors, TGFβ1 expression, and quality of life in breast cancer patients receiving post-operative radiotherapy: a prospective 6-month follow-up study. Clin Transl Oncol 25, 1287–1296 (2023). https://doi.org/10.1007/s12094-022-03024-1

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