Bronquiolitis obliterante con neumonía organizada: forma poco frecuente de toxicidad pulmonar en el tratamiento radioterápico del cáncer de mama

Clinical and Translational Oncology (Impact Factor: 1.28). 6(4):239-241. DOI: 10.1007/BF02711728

ABSTRACT The incidence of symptomatic pneumonitis in patients who had received radiation therapy for breast cancer is low (<1%). Recently,
bronchiolitis obliterans organizing pneumonia (BOOP) syndrome has been described as a secondary lung toxicity due to the radiation
therapy, which appears beyond the radiation field (migratory pneumonitis) and is triggered by hypersensitivity reactions mediated
by eosinophils, neutrophils and lymphocytes.

We present a patient who, two months after concluding the scheduled radiotherapy, developed a set of clinical, pathological
and radiological symptoms compatible with BOOP syndrome. The patient responded well to steroid treatment.

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    ABSTRACT: Breast-conserving surgery and postoperative radiotherapy have played important roles in the treatment of early breast cancer. Bronchiolitis obliterans organizing pneumonia (BOOP) syndrome has recently been reported to be one of the complications of adjuvant radiotherapy. The purpose of this study was to determine the incidence of and risk factors for BOOP syndrome in breast cancer patients. Between January 1996 and December 1998, 157 patients with breast cancer underwent radiotherapy after breast-conserving surgery. The criteria used for the diagnosis of BOOP syndrome were as follows: 1) radiation therapy to the breast within 12 months, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lung infiltrates outside the radiation port, and 4) no evidence of a specific cause. BOOP syndrome developed in 4 (2.5%) patients, who had fever and nonproductive cough, with patchy infiltrative shadows on chest roentgenograms which emerged between 5 and 6 months after radiotherapy. The symptoms and pulmonary infiltrates were rapidly improved by treatment with prednisone (40 mg/day), which was tapered over 2- to 5-month periods. However, BOOP syndrome relapsed in all cases during the tapering period or after withdrawal of prednisone. The eosinophil and neutrophil counts were increased and the ratios of CD4+ to CD8+ lymphocytes were elevated in bronchoalveolar lavage fluid in all four cases. There were no differences in proportions of patients by age, irradiated breast site, use of tamoxifen and/or chemotherapy, or radiation dose between those with and without BOOP syndrome. BOOP syndrome is considered an intractable form of lung toxicity after radiotherapy to the breast. An immunologic reaction mediated by eosinophils, neutrophils, and lymphocytes may be responsible for the development of this syndrome. Methods of prevention of BOOP syndrome should be established.
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    ABSTRACT: Reports of bronchiolitis obliterans organizing pneumonia (BOOP) occurring in women after radiation therapy for breast cancer have suggested that radiation to the lung could participate in the develop- ment of BOOP. We now describe the clinical, radiographic, functional, and bronchoalveolar lavage characteristics of this syndrome in a series of 15 patients reported to the Groupe d'Etudes et de Re- cherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P) in France. All 15 women (60 6 6 yr of age) fulfilled the following inclusion criteria: ( 1 ) radiation therapy to the breast within 12 mo, ( 2 ) general and/or respiratory symptoms lasting for at least 2 wk, ( 3 ) lung infiltrates outside the radia- tion port, and ( 4 ) no specific cause. The patients presented with fever, nonproductive cough, mild dyspnea, and peripheral alveolar opacities on chest radiograph with a characteristic migratory pat- tern. In five patients, BOOP was found at lung pathologic analysis. In all the patients dramatic im- provement was obtained with corticosteroids, but relapses occurred in 12 patients while tapering or after stopping corticosteroids. This report demonstrates that a characteristic BOOP syndrome may occur after radiation therapy to the breast, including tangential radiation to the lung, thus suggest- ing that radiation therapy may prime the development of BOOP. Crestani B, Valeyre D, Roden S, Wallaert B, Dalphin J-C, Cordier J-F, and the Groupe d'Etudes et de Recherche sur les Mala- dies Orphelines Pulmonaires (GERM"O"P). Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. AM J RESPIR CRIT CARE MED 1998;158:1929-1935.
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