Radiation pneumonitis in association with internal mammary node irradiation in breast cancer patients

An ancillary result from the KROG 08-06 study

Jinhyun Choi, Yongbae Kim, Kyung Hwan Shin, Sung Ja Ahn, Hyung Sik Lee, Won Park, Su Ssan Kim, Jin Hee Kim, Kyu Chan Lee, Dong Won Kim, Hyun Suk Suh, Kyung Ran Park, Hyun Soo Shin, Chang-Ok Suh

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)275-282
Number of pages8
JournalJournal of Breast Cancer
Volume19
Issue number3
DOIs
Publication statusPublished - 2016 Sep 1

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Radiation Pneumonitis
Radiation Oncology
Breast
Breast Neoplasms
Incidence
Lung
Radiotherapy
Thorax
Therapeutics
Radiography
Pneumonia

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Choi, Jinhyun ; Kim, Yongbae ; Shin, Kyung Hwan ; Ahn, Sung Ja ; Lee, Hyung Sik ; Park, Won ; Kim, Su Ssan ; Kim, Jin Hee ; Lee, Kyu Chan ; Kim, Dong Won ; Suh, Hyun Suk ; Park, Kyung Ran ; Shin, Hyun Soo ; Suh, Chang-Ok. / Radiation pneumonitis in association with internal mammary node irradiation in breast cancer patients : An ancillary result from the KROG 08-06 study. In: Journal of Breast Cancer. 2016 ; Vol. 19, No. 3. pp. 275-282.
@article{d5919191a3d646a298eeace3f0bac3a0,
title = "Radiation pneumonitis in association with internal mammary node irradiation in breast cancer patients: An ancillary result from the KROG 08-06 study",
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 = "Jinhyun Choi and Yongbae Kim and Shin, {Kyung Hwan} and Ahn, {Sung Ja} and Lee, {Hyung Sik} and Won Park and Kim, {Su Ssan} and Kim, {Jin Hee} and Lee, {Kyu Chan} and Kim, {Dong Won} and Suh, {Hyun Suk} and Park, {Kyung Ran} and Shin, {Hyun Soo} and Chang-Ok Suh",
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doi = "10.4048/jbc.2016.19.3.275",
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Radiation pneumonitis in association with internal mammary node irradiation in breast cancer patients : An ancillary result from the KROG 08-06 study. / Choi, Jinhyun; Kim, Yongbae; Shin, Kyung Hwan; Ahn, Sung Ja; Lee, Hyung Sik; Park, Won; Kim, Su Ssan; Kim, Jin Hee; Lee, Kyu Chan; Kim, Dong Won; Suh, Hyun Suk; Park, Kyung Ran; Shin, Hyun Soo; Suh, Chang-Ok.

In: Journal of Breast Cancer, Vol. 19, No. 3, 01.09.2016, p. 275-282.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiation pneumonitis in association with internal mammary node irradiation in breast cancer patients

T2 - An ancillary result from the KROG 08-06 study

AU - Choi, Jinhyun

AU - Kim, Yongbae

AU - Shin, Kyung Hwan

AU - Ahn, Sung Ja

AU - Lee, Hyung Sik

AU - Park, Won

AU - Kim, Su Ssan

AU - Kim, Jin Hee

AU - Lee, Kyu Chan

AU - Kim, Dong Won

AU - Suh, Hyun Suk

AU - Park, Kyung Ran

AU - Shin, Hyun Soo

AU - Suh, Chang-Ok

PY - 2016/9/1

Y1 - 2016/9/1

N2 - 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.

AB - 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.

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DO - 10.4048/jbc.2016.19.3.275

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JO - Journal of Breast Cancer

JF - Journal of Breast Cancer

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