Abstract
Introduction: Both earlier diagnoses of the breast cancer and novel chemo radiation therapy strategies have resulted in a considerable improvement in breast cancer survival. This study was intended to assess the long term impact of these treatment modalities on pulmonary functions in survivors of carcinoma breast patients in Kashmir valley of Indian subcontinent.
Material and Methods: A prospective study in which breast cancer patients treated by combined modality treatment protocol with curative intent were taken for study. Patients with any co-morbid medical conditions like chronic lung disease, hypertension, asthma or drug intake for the same or any were not included in the study. Patients included in the study group had histopathological documentation of Carcinoma Breast, female sex, age greater than 18 years and geographical location of Kashmir Valley. Respiratory status assessment was done by pulmonary function test (spirometry) according to the guidelines prescribed in the American Thoracic Society (ATS) guidelines. The pulmonary function test values were compared with the patient’s predicted values and percentage change was calculated
Observations: While assessing pulmonary functions in the study group cases, revealed slight restrictive ventilatory impairment in contrast to control group cases in the form of reduction in various spirometric parameters. Radiation and chemotherapy have synergistic effect on reduction in the spirometric parameters. The follow up time was less, need more follow up time.
Conclusion: Apart from the clear benefits of adjuvant chemo radiation, we should be aware of the potentially increased risk of pulmonary sequelae following specific radiotherapy regimens in long-term breast cancer survivors.
Keywords: breast cancer, long term toxicity, fibrosis, chemo radiation, pulmonary sequelae.
References
- Berry DA, Cranin KA. Plevritis SK et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353;1784-1792:2005.
- Marks LB, Yu X, Prosnitz, RG, et al. the incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiol Oncol Biol Phys 2005;63:214-223.
- Marks LB, Hollis D, Munley M, et al. the role of lung perfusion imaging in predicting the detection of radiation-induced changes in pulmonary function tests. Cancer 2000;88:2135-2141.
- EBCTCG Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and on 15 year survival: an overview of the randomized trials. Lancet 2005.
- Violet JA, Harmer C. Breast cancer: improving outcome following adjuvant radiotherapy. Br J Radiol2004;77:811–20.
- CC Ooi, DL Swong JC Ho et al, International Journal of Radiation Oncology Biology Physics. Volume 50, issue 2, 1 June 2001, p. 411-419.
- Koc M, Polat P, Suma S. Department of Radiation Oncology, Faculty of Medicine, Atatürk University, Erzurum, Turkey. 2002 Aug;64(2):171-5
- Nicole Simone, MD, and colleagues. American Society for Radiation Oncology (ASTRO) 53rd Annual Meeting: Abstract 11. Presented October 3, 2011.
- American Thoracic Society, Standardiza-tion of Spirometry 1994 update: Statement of the American Thoracic Society Am J RespirCrit Care Med 1995; 152:1107-36.
- Sunita Saxena, Bharat Rekhi, Anju Bansal, Ashok Bagga,Chintamani et al. Clinicomorphological patterns of breast cancer including family history in New Delhi hospital, India- a cross sectional study. World journal of surgical oncology 2005, 3:67
- Raina V.,M. Bhutani, R. Bedi, A. Sharma, S. Deo, N.K. Shukla.B. K. Mohanti, G. Rath; journal of clinical oncology, 2004 ASCO Annual meeting proceedings (Post-Meeting Edition). BoL 22, No14s (July 15 supplement, 2004: 686)
- Fakhro A. E., B.E. Fateha, N. Al-Asheeri and S. A. Al-Ekri. Breast cancer: patient characteristics and survival analysis at Salmaniya Medical Complex, Bharain. Eastern Mediterranean Health Journal. Volume 5, Issue 3,1999, Page 430-439
- Priya Hazrah, Rajender Parshad, Mashaal Dhir, Rajiv Sing. Factors associated with attrition in patients with breast cancer; A retrospective study. Natl Med J India 2007;20: 230-3
- Org: Epidemiology of breast cancer http://medicineworld.org/cancer/breast/epidemiology-of-breast-cancer.html
- Arshad Mehmood Malik, Rafique Pathan, Noshad Ahmed Shaikh, Jawaid Naeem Qureshi, Khamiso Altaf Hussain Talpur. Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Hyderabad, Sindh. (JPMA 60:718; 2010).
- By May Brit Lund, MD, Kurt IngeMyhre, MD, Haakon Melsom, MD and Bjorn Johansen, MD University of Oslo, Department of Thoracic Medicine, Rikshospitalet, The National Hospital, and The Norwegian Radium Hospital, Oslo, Norway 1991, The British Journal of Radiology, 64, 520-523
- Huang EY, Wang CJ, Chen HC, Sun LM, Fang FM, Yeh SA, Hsu HC, Hsiung CY, Wu JM. Department of Radiation Oncology, Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan. Radiotherapy Oncol. 2000 Oct;57(1):91-6.
Corresponding Author
Wani Shahid Bashir
Senior Resident, Radiation Oncology SKIMS Srinagar
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.155
