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Effect of Radiotherapy and Chemotherapy on Pulmonary Function After Treatment for Breast Cancer and Lymphoma: A Follow-Up Study

From the Departments of Radiotherapy, Nuclear Medicine, and Chest Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Huis, Amsterdam, the Netherlands.

Address reprint requests to J.V. Lebesque, MD, PhD, Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; email jlebes{at}nki.nl

PURPOSE: To determine the changes in pulmonary function tests (PFTs) 0 to 48 months after treatment for breast cancer and lymphoma.

PATIENTS AND METHODS: The alveolar volume (V_A), vital capacity, forced expiratory volume in 1 second, and corrected transfer factor of carbon monoxide (T_L,COc) were measured in 69 breast cancer and 41 lymphoma patients before treatment and 3, 18, and 48 months after treatment with radiotherapy alone or radiotherapy in combination with chemotherapy (mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastine; cyclophosphamide, epidoxorubicin, fluorouracil; cyclophosphamide, thiotepa, carboplatin; cyclophosphamide, methotrexate, fluorouracil). The three-dimensional dose distribution in the lung of each patient was converted to the mean lung dose. Statistical analysis was used to evaluate the changes in PFT values over time in relation to age, sex, smoking, chemotherapy, and the mean lung dose.

RESULTS: After an initial reduction in PFT values at 3 months, significant recovery was seen at 18 months for all patients. Thereafter, no further improvement could be demonstrated. Reductions in spirometry values and V_A were related to the mean lung dose only (0.9% per Gy at 3 months and 0.4% per Gy mean dose at 18 months). T_L,COc decreased 1.1% per Gy mean dose and additionally decreased 6% when chemotherapy was given after radiotherapy. Chemotherapy administered before radiotherapy reduced baseline T_L,COc values by 8% to 21%. All patients showed an improvement of 5% at 18 months.

CONCLUSION: On the basis of the mean lung dose and the chemotherapy regimen, the changes in PFT values can be estimated before treatment within 10% of the values actually observed in 72% to 85% of our patients with healthy lungs.

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