Bronquiolitis obliterante con neumonía organizada: forma poco frecuente de toxicidad pulmonar en el tratamiento radioterápico del cáncer de mama
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: To describe six cases of radiation-induced organizing pneumonitis occurring outside the direct radiation field and to review clinical, radiologic, and histologic aspects of this entity. We present detailed case reports of six women, with a mean age of 62.8 years (range, 50 to 75), who had received radiation therapy (mean dose, 6,560 cGy) for breast cancer. From 6 to 17 months (mean, 8.8) after the completion of radiotherapy, recurrent and migrating lung infiltrates were detected outside the radiation field in the six study patients. Three patients had pronounced respiratory symptoms, whereas the rest were minimally symptomatic or asymptomatic. Thoracic computed tomography showed dense alveolar infiltrates. Bronchoalveolar lavage in two patients revealed lymphocytosis (25% and 19%), and lung biopsy in five patients demonstrated a histologic pattern consistent with bronchiolitis obliterans organizing pneumonia. Even though the symptomatic patients showed prompt resolution of their symptoms and roentgenographic abnormalities after systemic corticosteroid therapy, the lung infiltrates recurred after corticosteroid therapy was discontinued. These six cases, including their prompt response to corticosteroid therapy, provide additional evidence that irradiation damages lung tissue outside of the direct treatment field and suggest that an immunologically mediated lymphocytic alveolitis may be responsible for the recurrent migratory organizing pneumonitis.Mayo Clinic Proceedings 02/1999; 74(1):27-36. · 5.79 Impact Factor
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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.International Journal of Radiation OncologyBiologyPhysics 11/2000; 48(3):751-5. · 4.52 Impact Factor
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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.American Journal of Respiratory and Critical Care Medicine 12/1998; 158(6). · 11.04 Impact Factor