Pulmonary fibrosis and its rehabilitation after radiation therapy for breast cancer.

OBJECTIVES

Postoperative radiotherapy (RT) for breast cancer (BC) improves survival by preventing local recurrence but can lead to radiation-induced pulmonary fibrosis (RIPF). RIPF typically appears within 6-12 months post-RT and may progress over 2 years. This study assessed RIPF development in BC patients undergoing hypofractionated RT and evaluated the effects of rehabilitation interventions.

METHODS

A total of 209 BC patients were observed: 106 in the study group received rehabilitation, while 103 in the control group followed the standard protocol. Rehabilitation included medications (Aquadetrim, Adenorin, Contimax, Magnesium B6) and topical sodium nucleonate spray. All patients received an average dose of 42.56 Gy over 16 sessions.

RESULTS

RIPF developed in 90.3% of patients, with an average onset at 8.7 months post-RT. Rehabilitation delayed RIPF onset-by 8.9 months in the control group vs. 9.8 months in the rehabilitation group-showing a 9.9% improvement (P = .034). Body mass index (BMI) was a significant factor: patients with BMI >25 developed RIPF earlier (7.5 months) than those with BMI <25 (11.3 months, P = .005). Age and cancer side had no significant effect, though right-sided BC showed slightly earlier onset. Grade 2 skin reactions were linked to higher fibrosis incidence, though not statistically significant.

CONCLUSIONS

Rehabilitation may delay RIPF onset, and BMI appears to be a strong predictor of its development. Future research should explore additional risk factors for RIPF in BC patients post-RT.

ADVANCES IN KNOWLEDGE: This study is among the first to show that targeted rehabilitation protocols may effectively delay RIPF onset after hypofractionated RT in BC patients.