Serial HRCT lung changes after 3-field radiation treatment of breast cancer

AIMS: To document serial high resolution computed tomography (HRCT) features of lung injury after 3-field radiotherapy for breast cancer. MATERIALS AND METHODS: Thirty women who received opposing tangential chest wall and supraclavicular field (SCF) irradiation after breast surgery were recruited. Thoracic HRCT was performed before and at 1, 3, 6 and 12 months after radiotherapy (RT). Lung injury at 3 months was quantified by applying a scoring system to each HRCT section. Findings were correlated with spirometric lung function tests. RESULTS: There was HRCT evidence of lung injury in 27 (90%) women at I month and in all 30 patients at 3 months. Spirometric lung function declined post-RT (P<0.05), correlating with an increased SCF acute lung injury score at 3 months [r = -0.54 and -0.46, P = 0.01 and 0.03 for forced expiratory volume in 1st (FEV1) and forced vital capacity (FVC), respectively], Lung injury on HRCT progressed from ground glass opacification at I month to nodular consolidation (3 months), increasing linear densities (6 months), and finally to residual subpleural linear and dense opacities (12 months). CONCLUSION: There is a high incidence of lung injury associated with 3-field radiotherapy for breast cancer, with concurrent SCF irradiation increasing the risk of lung damage and functional impairment. A characteristic sequence of HRCT changes is seen in most patients receiving this type of radiotherapy. (C) 2000 The Royal College of Radiologists.