Assessment of pulmonary toxicities in breast cancer patients undergoing treatment with anthracycline and taxane based chemotherapy and radiotherapy- a prospective study
Background: Anthracycline based regiments and/or taxanes and adjuvant radiotherapy; the main modalities of treatment for breast cancers are associated with deterioration of pulmonary functions and progressive pulmonary toxicities.
Aim: Assessment of pulmonary toxicities and impact on pulmonary functions mainly in terms of decline of forced vital capacity (FVC) and the ratio of forced expiratory volume (FEV) in 1 Second and FEV1/FVC ratio with different treatment times and follow ups in carcinoma breast patients receiving anthracycline and/or taxane based chemotherapy and radiotherapy.
Materials and methods: A prospective single institutional cohort study was performed with 58 breast cancer patients between January 2011 to July 2012 who received either anthracycline based (37 patients received 6 cycles FAC= 5 FU, Adriamycin, Cyclophosphamide regime) and radiotherapy or anthracycline and taxane based chemotherapy (21 patients received 4cycles AC= Adriamycin, Cyclophosphamide; followed by 4 cycles of T=Taxane) and radiotherapy. Assessment of pulmonary symptoms and signs, chest x-ray and pulmonary function tests were performed at baseline, midcycle, at end of chemotherapy, at end radiotherapy, at 1 and 6 months follow ups and compared. By means of a two-way analysis of variance (ANOVA) model, the course of lung parameters across the time points was compared.
Results and Conclusion: Analysis of mean forced vital capacities at different points of study times showed definitive declining pattern, which is at statistically significant level at the end of 6th month of follow up (p=0.032) .The FEV1/FVC ratio (in percentage) also revealed a definite decreasing pattern over different treatment times and at statistically significant level at 6th month follow up with p value 0.003. Separate analysis of mean FEV1/FVC ratios over time in anthracycline based chemotherapy and radiotherapy group as well as anthracycline and taxane based chemotherapy and radiotherapy group showed a similar declining pattern.
Cite this article as:
Saha A, Chattopadhyay S. Assessment of pulmonary toxicities in breast cancer patients undergoing treatment with anthracycline and taxane based chemotherapy and radiotherapy- a prospective study. Int J Cancer Ther Oncol 2013; 1(2):01021.
Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J.(eds) Cancer incidence in five continents VII. International agency for research on cancer, Lyon, France. IARC Sci Pub No. 143; 1997.
National Cancer Registry Programme Biennial Report (1988–89): An epidemiological study. Indian Council of Medical Research, New Delhi; 1992.
Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005; 353:1784.
Nabholtz JM, Gligorov J. The role of taxanes in the treatment of breast cancer. Expert Opin Pharmacother 2005; 6:1073-94.
Shannon VR, Price KJ. Pulmonary complications of cancer therapy. Anesth Clin N Amer 1998; 16:563– 86.
Ramanathan RK, Reddy VV, Holbert JM, et al. Pulmonary infiltrates following administration of paclitaxel. Chest 1996; 110:289– 92.
Dimopoulou I, Galani G, Dafni U, et al. A prospective study of pulmonary function in patients treated with paclitaxel and carboplatin. Cancer 2002; 94:452–8.
Henderson IC, Berry DA, Demetri GD, Cirrincione CT, Goldstein LJ,Martino S, et al. Improved outcomes from adding sequential paclitaxel but not from escalating doxorubicin dose in an adjuvant chemotherapy regimenfor patients with node-positive primary breast cancer. J Clin Oncol 2003; 21:976–83.
Mamounas EP, Bryant J, Lembersky BC, Fisher B, Atkins JN, Fehrenbacher L, et al. Paclitaxel (T) following doxorubicin/cyclophosphamide (AC) as adjunct chemotherapy for node-positive breast cancer: results from NSABP B-28 [abstract 12]. Proc ASCO 2003; 22:4.
Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997; 337:949 –55.
Early Breast Cancer Trialists’ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 2000; 355:1757–70.
Lind PA, Marks LB, Hardenbergh PH, Clough R, Fan M, Hollis D, et al. Technical factors associated with radiation pneumonitis after local /regional radiation therapy for breast cancer. Int J Radiat Oncol Biol Phys 2002; 52:137– 43.
Botterman J, Tasson J, Schelstraete K, Pauw els R, VanDerStraeten M, DeSchryver A. Scintigraphic, spirometric and roentgenologic effects of radiotherapy on normal lung tissue. Chest 1990; 97:97-102.
Kaufman J, Gunn W, Hartz AJ, et al. The pathophysiologic and roentgenologic effects of chest irradiation in breast carcinoma. Int J Radiat Oncol Biol Phys 1986; 12:887–893.
Quanjer PH. Standardized lung function testing. Report from working party ‘Standardization of lung function tests’, European Community for Coal and Steel. Bull Eur Physiopathol Resp 1983; 19:1–27.
Yu TK, Whitman GJ, Thames HD, Buzdar AU, Strom EA, Perkins GH, Schechter NR, McNeese MD, Kau SW, Thomas ES, Hortobagyi GN, Buchholz TA. Clinically relevant pneumonitis after sequential paclitaxel-based chemotherapy and radiotherapy in breast cancer patients. J Natl Cancer Inst. 2004 17; 96:1676-81.
Marks LB, Halperin EC, Prosnitz LR, et al. Post-mastectomy radiotherapy following adjuvant chemotherapy and autologous bone marrow transplantation for breast cancer patients with≥10 positive axillary lymph nodes. Int J Radiat Oncol Biol Phys 1992; 23:1021–1026.
Gage I, Bond S, Davidson NE, et al. Minimal acute toxicity with locoregional radiation therapy follow ing 2 high-dose chemotherapy regimens (HDC) supported with autologous marrow/stem-cell transplantation in high risk breast cancer patients (abstract). Prog/Proc ASCO 1998; 17:120a.
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