radiation pneumonitis

[NanaJoni]

Has anyone had any experience with radiation pneumonitis - inflammation of lung tissue from radiation treatments??? I have been diagnosed with this and am very nervous about the damage that may have been done to my lungs. Have had two hospitalizations in the last month (first for "pneumonia" and then last week to actually find out that there was the "underlying" problem of the tissue damage from the radiation). Shortness of breath and am now having to use oxygen at night - I see the pulmonologist again on 5/18 but just wondered if anyone had similar experience???

[Trish]

Sorry I have no experience of pneumonitis but I did want to send you my best wishes for the success of your treatment.
Trish

[Lani]

DON'T KNOW WHAT YOUR CURRENT MED REGIMEN IS, BUT HERCEPTIN'S DRUG WARNING INCLUDES PNEUMONITIS I BELIEVE AND I REMEMBERED FILING AWAY THE FOLLOWING:

1: Breast Cancer Res Treat. 2008 Mar 16 [Epub ahead of print]
Life-threatening interstitial lung disease associated with trastuzumab:
case report.
Pepels MJ, Boomars KA, van Kimmenade R, Hupperets PS.
Division of Medical Oncology, Department of Internal Medicine, University Hospital
Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands,
mpepels@hotmail.com.
A female patient with HER2 positive, metastatic breast cancer
presented with pulmonary infiltrates, and a plural effusion dyspnoea
after several months of trastuzumab treatment. She had been treated
without complications with six courses of docetaxel and trastuzumab
in combination with dexamethasone with partial remission of disease.
Malignancy, infection and cardiomyopathy were excluded as causes of
dyspnoea. Pleural and broncheoalveolar fluid analyses (BAL) showed
eosinophils. A diagnosis of trastuzumab-induced pneumonitis was
made. After treatment with steroids there was gradual clinical
improvement and disappearance of infiltrates. Although a causative
association between trastuzumab and this patient's pulmonary
syndrome was not proven, the potential for this toxicity should be
considered.
PMID: 18343993 [PubMed - as supplied by
publisher]

NOTE THE ABOVE PATIENT'S PROBLEM WAS NOT PROVEN TO BE DUE TO HERCEPTIN, BUT THE DRUG INFORMATION LISTS PULMONARY SIDE EFFECTS
SO IT MIGHT BE WORTH HAVING YOUR ONCOLOGIST CALL ROCHE/GENENTECH AND SEE HOW MANY POST-MARKETING CASES LIKE YOURS THEY HAVE TALLIED AND WHAT WORKED FOR THEM

PLEASE DON'T PANIC FROM THIS INFO--IT IS MEANT TO HELP YOU GATHER WHATEVER INFO MIGHT BE HELPFUL TO GET YOU THE BEST TREATMENT

I ALSO DON'T KNOW HOW LONG IT IS SINCE YOU HAD THE RADIATION

DO THEY THINK IT IS MORE LIKELY IT IS DUE TO THE RADIATION, THE HERCEPTIN OR THE COMBINATION?

HOPE SOME OF THIS HELPED

[NanaJoni]

Lani - thanks so much for this info. I have a gut feeling that this may be a combination of the Herceptin and the radiation. The inflammation is right where I had the concentrated radiation in the area of my tumors in the right breast so the radiation component is likely. But I've had other problems with the Herceptin (gastro mostly) that have significantly improved in the two months since I last had a treatment. I saw my onc Wednesday and he has decided to stop all treatments - I only had 3 left so it's not a big deal. I'll see him every 4 months now and am getting my port out on 5/9. I'm not one to panic - but am very impatient with the continuing shortness of breath. I saw my primary care doc this morning and she feels the inflammation can be reduced with some low dose steroids and that the pulmonologist will probably start me on that when I see him on 5/18. I've printed out this info you posted and will be taking it with me when I see him. Thanks again for the info and the kindness you've shown.

[Jackie07]

Found some newer abstracts on the subject:

Breast Cancer. 2011 Apr 28. [Epub ahead of print]
Safety of adjuvant trastuzumab for HER-2-overexpressing elderly breast cancer patients: a multicenter cohort study.
Sawaki M, Mukai H, Tokudome N, Nakayama T, Taira N, Mizuno T, Yamamoto Y, Horio A, Watanabe T, Uemura Y, Ohashi Y.
Source
Department of Clinical Oncology and Chemotherapy, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan, m-sawaki@med.nagoya-u.ac.jp.
Abstract
BACKGROUND:
For targeting anti-HER-2, trastuzumab-incorporated chemotherapy is the standard for HER-2-overexpressing breast cancer in adjuvant settings. But there are few data on trastuzumab in elderly patients. We evaluated the incidence of adverse events among an elderly population of trastuzumab-treated HER-2-positive breast cancer patients in adjuvant settings.
METHODS:
Data on 39 elderly HER-2 overexpressing breast cancer patients treated with both curative surgery and adjuvant trastuzumab were retrospectively collected from a Japanese multicenter study. The loading dose was 8 mg/kg body weight, and the maintenance dose was 6 mg/kg every 3 weeks; or the loading dose was 4 mg/kg followed by 2 mg/kg weekly as maintenance.
RESULTS:
After a median follow-up of 20.0 (2.4-53.9) months, a total of 32 patients (82.1%) completed 1-year trastuzumab treatment. The median treatment duration was 12.0 months (range 2-12; mean 10.5). Adverse events occurred in 11 patients (28.2%). Four (10.2%) discontinued or interrupted treatment after experiencing toxicity. One patient died because of interstitial pneumonia. Three patients (7.7%) had congestive heart failure (CHF), one of whom had a history of angina. Three patients (7.7%) had a lower left ventricular ejection fraction (LVEF), and brain natriuretic peptide elevation was totally observed in three patients (7.7%). Three patients with lower LVEF had received chemotherapy containing doxorubicin before trastuzumab. Of the three patients, two discontinued therapy because of CHF, but all recovered with proper medication containing a diuretic agent.
CONCLUSIONS:
Elderly patients tolerated trastuzumab well, although careful management is needed.

Case Rep Oncol. 2011 Apr 2;4(1):186-91.
Delayed Paclitaxel-trastuzumab-induced interstitial pneumonitis in breast cancer.
Abulkhair O, El Melouk W.
Source
King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
Abstract
Pneumonitis is a rare but serious complication associated with paclitaxel and/or trastuzumab treatment. We report a 51-year-old female patient with locally advanced breast cancer who presented with shortness of breath, fever, dry cough and pulmonary infiltrates. She had been treated without complications for 10 weeks with paclitaxel (Taxol®) and trastuzumab (Herceptin®) as neoadjuvant therapy, with complete clinical and pathological response. Infections and cardiomyopathy were excluded as causes of her symptoms. Bronchoscopy and biopsy were performed and a diagnosis of drug-induced interstitial pneumonitis was made. After treatment with steroids, the patient showed a significant response in less than 24 h; she was discharged home without the need for oxygen less than 48 h after therapy initiation. Although no causative association could be found between either trastuzumab or paclitaxel and this patient's pulmonary syndrome, the potential for such toxicity should be considered, especially as paclitaxel/trastuzumab is a vey common combination therapy for breast cancer.

Radiat Oncol. 2010 Oct 29;5:99.
Reduction of radiation pneumonitis by V20-constraints in breast cancer.
Blom Goldman U, Wennberg B, Svane G, Bylund H, Lind P.
Source
Department of Oncology, Karolinska University Hospital, Stockholm, Sweden. ulla.blom-goldman@karolinska.se
Abstract
INTRODUCTION:
Adjuvant local-regional radiotherapy (LRRT) is routinely recommended for breast cancer patients. It is well known being related to pulmonary side-effects. We studied post-RT radiological changes on X-ray and CT, and correlated the findings with Quality of Life (QoL), common dosimetric factors and co-variates. The results were compared with a previously reported cohort of 137 irradiated women.
METHODS:
88 women underwent chest X-ray and CT pre-and 4-5 months after 3-D planned LRRT, minimizing the dose to the ipsilateral lung to V₂₀ < 30%. The lung field was divided into 3 regions and the development of post-RT density changes were graded (0-3). Patients with radiological changes were compared with non-responders. Clinical symptoms were registered and data on patient and treatment related co-variates were gathered prospectively. The ipsilateral lung dosimetric factors V₁₃, V₂₀, V₃₀ and mean dose were calculated and QoL was assessed before and 4 months after RT.
RESULTS:
The use of dose-volume constraints significally reduced moderate-severe radiological changes on chest X-ray compared with our earlier study (Chi square trend test: p < 0.001). Symptomatic pneumonitis was also rare in the present study. No agreement was found between CT and chest X-ray as diagnostic tools for post-RT pneumonitis. V13 correlated independently with radiological changes on CT (logistic regression: p = 0.04; ROC area: 0.7). The Co-variates smoking habits, age, chemotherapy, endocrine or trastuzumab therapy did not influence the outcome on multivariate analysis. QoL changes in physical function, i.e. fatigue, dyspnoea were not detected but there was a trend for a worse recovery after chemotherapy in patients with high V13 (Spearman Rank Correlation: p < 0.05).
CONCLUSIONS:
The use of dose-volume constraints significantly reduced post-RT radiological changes on chest X-ray in LRRT for BC. The lung changes on CT were also generally limited when we used this strategy and was not always picked up on chest X-ray. Variation in V₁₃ alone was correlated with occurrence of lung changes on CT

[Jackie07]

Just realized that the original question is about the side effect of radiation treatment:

Radiat Oncol. 2010 Nov 23;5:112.
Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity.
Deantonio L, Gambaro G, Beldì D, Masini L, Tunesi S, Magnani C, Krengli M.
Source
Department of Radiotherapy, University Hospital Maggiore della CaritÃ*, Novara, Italy.
Abstract
BACKGROUND:
A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series.
METHODS:
Eighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected.
RESULTS:
Overall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85%) patients treated with hypofractionation and in 67/70 (96%) patients treated with conventional fractionation (p = 0.01). Late toxicity was observed in 8 patients (10%) in the hypofractionation group and in 10 patients (15%) in the conventional fractionation group, respectively (p = 0.4).
CONCLUSIONS:
The hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice.


Strahlenther Onkol. 2010 Nov;186(11):630-6. Epub 2010 Nov 8.
Fibrotic changes after postmastectomy radiotherapy and reconstructive surgery in breast cancer. A retrospective analysis in 109 patients.
Classen J, Nitzsche S, Wallwiener D, Kristen P, Souchon R, Bamberg M, Brucker S.
Source
Department of Radiation Oncology, Tübingen University, Tübingen, Germany. johannes.classen@vincentius-ka.de
Abstract
PURPOSE:
The purpose of this study was to analyze the probability and time course of fibrotic changes in breast reconstruction before or after postmastectomy radiotherapy (PMRT).
MATERIALS AND METHODS:
Between 1995 and 2004, 109 patients were treated with PMRT at Tübingen University and underwent heterologous (HL) or autologous (AL) breast reconstruction prior or subsequent to radiation therapy. Fibrosis of the reconstructed breast after radiotherapy was assessed using the Baker score for HL reconstructions and the Common Terminology Criteria for Adverse Events (CTCAE) for all patients. Actuarial rates of fibrosis were calculated for the maximum degree acquired during follow- up and at the last follow-up visit documented.
RESULTS:
Median time to follow-up was 34 months (3-227 months). Radiotherapy was applied with a median total dose of 50.4 Gy. A total of 44 patients (40.4%) received a boost treatment with a median dose of 10 Gy. Breast reconstruction was performed with AL, HL, or combined techniques in 20, 82, and 7 patients, respectively. The 3-year incidence of ≥ grade III maximum fibrosis was 20% and 43% for Baker and CTCAE scores, respectively. The corresponding figures for fibrosis at last follow-up visit were 18% and 2%. The 3-year rate of surgical correction of the contralateral breast was 30%. Initially unplanned surgery of the reconstructed breast was performed in 39 patients (35.8%). Boost treatment and type of cosmetic surgery (HL vs. AL) were not significantly associated with the incidence of fibrosis.
CONCLUSIONS:
We found severe fibrosis to be a frequent complication after PMRT radiotherapy and breast reconstruction. However, surgical intervention can ameliorate the majority of high grade fibrotic events leading to acceptable long-term results. No treatment parameters associated with the rate of fibrosis could be identified.


Int J Radiat Oncol Biol Phys. 2011 Feb 1;79(2):408-13. Epub 2010 May 6.
Evaluation of acute locoregional toxicity in patients with breast cancer treated with adjuvant radiotherapy in combination with bevacizumab.
Goyal S, Rao MS, Khan A, Huzzy L, Green C, Haffty BG.
Source
Department of Radiation Oncology, The Cancer Institute of New Jersey, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA. goyalsh@umdnj.edu
Abstract
PURPOSE:
Preclinical studies have shown that bevacizumab combined with radiotherapy (RT) induces a radiosensitizing effect. Published reports regarding the safety of combination therapy involving bevacizumab and RT are lacking. The purpose of this study was to analyze acute locoregional toxicity in patients with breast cancer receiving concurrent bevacizumab plus RT.
METHODS AND MATERIALS:
After institutional review board approval was obtained, patients with breast cancer who received bevacizumab were identified; these patients were then cross-referenced with patients receiving RT. Toxicity was scored by the Common Terminology Criteria for Adverse Events. Patients were matched 1:1 with those who did not receive bevacizumab. Statistical analysis was performed to analyze toxicity between the two groups.
RESULTS:
Fourteen patients were identified to have received bevacizumab plus RT. All patients received bevacizumab during RT without delay or treatment breaks; there were no RT treatment breaks in all patients. No patient receiving bevacizumab plus RT experienced ≥Grade 3 toxicity; 3 matched control patients experienced a Grade 3 skin reaction. There was no difference in fatigue, radiation fibrosis, pneumonitis, or lymphedema between the two groups. Five patients (35%) developed reduction in ejection fraction; 2 with right-sided and 3 with left-sided treatment. Patients with left-sided treatment experienced a persistent reduction in ejection fraction compared with those receiving right-sided treatment.
CONCLUSION:
Concurrent bevacizumab and RT did not increase acute locoregional toxicity in comparison with matched control patients who did not receive RT alone. The addition of concurrent RT when treating the intact breast, chest wall, and associated nodal regions in breast cancer seems to be safe and well tolerated.