Early skin and lung reactions in breast cancer patients after radiotherapy: prospective study

Purpose : The association between early radiological lung reactions consequent upon radiotherapy and patients' symptoms is not well established. This prospective study examined the association between symptoms experienced by the patient, clinical findings observed by the physician and reactions visible in chest X-ray as interpreted by a radiologist, as well as the association between skin or breast symptoms and lung symptoms induced by radiotherapy after different methods of surgery. Methods : Altogether 207 consecutive breast cancer patients entered the trial between 1st October 1997 and 31st December 1998. Chest X-rays were taken at entry and 3, 6 and 12 months after radiotherapy. The frequency and intensity of symptoms as well as clinical and chest X-ray findings were assessed over time. Results : Skin and breast symptoms were common after radiotherapy but seldom severe (9%). Lung reactions were seen in chest X-ray in 47% of patients in re-evaluation by a radiologist at 3 months. The frequency of lung or skin symptoms did not correlate with chest X-ray findings, but there was a significant correlation between skin and lung symptoms. Radiotherapy after conservative surgery for node-positive breast cancer caused lung reactions seen in chest X-ray more often than after mastectomy when using other techniques. The reactions were most common at the 6 month evaluation ( P =0.01). Concomitant adjuvant chemo- or endocrine therapy did not significantly increase the incidence of lung reactions. Conclusions : Skin, breast and lung symptoms were frequent after radiotherapy, but there was no real association between lung or skin symptoms and chest X-ray findings. The only correlation noted was between skin or breast symptoms and lung symptoms experienced by patients. Radiotherapy after conservative surgery was more frequently linked to chest X-ray findings than radiotherapy after mastectomy. We conclude that routine chest X-ray after radiotherapy gives no more clinically relevant information than the symptoms of the patient and we do not recommend routine chest X-rays for that reason.