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Title: Effect of radiotherapy for breast cancer on total and regional lung function
Author: Kanbour, Amal Ibrahim Muhamad
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1978
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When modern high voltage radiotherapy is used in combination with simple mastectomy for the treatment of breast cancer, the lung apex on the treated side receives up to 4250 cads. Minor changes in overall lung function following such therapy have previously been reported (Emirgil and Heinemann, 1961). These changes are more pronounced when radiation pneumonitis develops, which occurs in about 11% of such patients (Gross, 1977). Two groups of patients were studied, both having had simple mastectomy followed by megavoltage radiotherapy (4250 rads to the axilla and supraclavicular region and 4500 cads to the chest wall by tangential fields, in 10 fractions over four weeks), as part of their treatment of carcinoma of the breast. Overall and regional lung function measurements, chest x-ray and electrocardiograph were carried out in each patient. Overall lung function was assessed by static lung volumes (TLC, VC, RV, RV/TLC%), dynamic lung volumes (FEV1, FVC, FEV1/FVC%), transfer factor of carbon monoxide (TCO), flow volume curves and airways resistance. Regional distribution of ventilation was measured with radioactive Xe133, and regional distribution of perfusion with radioactive Xe133 in the first study and with TC99m macro-aggregated albumin in the second study, using a gamma camera linked on-line to a computer. The first study involved a longitudinal sequential measurement in the same group of ten patients prior to radiotherapy, but after simple mastectomy "control", and at 1, 3, 6, 9 and 12 months after radiotherapy. There were no significant changes in VC, FVC, TCO, Vmaxso, Vmax30 and sGaw after radiotherapy, as compared to control values. However, there was a significant reduction at 5% level in TLC, RV and in FEV1 at 6, 9 and 12 months after radiotherapy, as compared to the control values. Chest x-rays were unchanged in most of these patients. Comparison of regional ventilation between the irradiated lung and non-irradiated "control" lung at the same vertical height showed no changes either before radiotherapy or sequentially at 1, 3, 6, 9 and 12 months thereafter. However, there was a significant reduction in perfusion of the upper zones of the irradiated lung corresponding to the region receiving the radiotherapy in most of these patients. This perfusion reduction was significant at the 5% level at 1 month and at 6 months after radiotherapy, but was not significant thereafter. The second study was a cross-sectional one in a group of 48 patients at an interval of one to fourteen years after radiotherapy, given by the same technique. The chest x-rays showed some changes in 52% of these patients. Their values of TLC, VC and FEV1 were distributed around 100% of the predicted normal value, thus showing normal values, but their TCO was below 100% of the predicted normal value in most. There was no significant change in regional ventilation between the irradiated and the non-irradiated lungs, when compared at the same vertical height, but there was a highly significant reduction in perfusion of the upper zones of the irradiated lung as compared to the non-irradiated "control" lung in the same patient. It is concluded that: 1. This dose and technique of radiotherapy had little effect on overall lung function in these women with normal lungs. 2. However, perfusion to the alveolus was reduced in the irradiated region, without clinical or radiological changes, from as little as one month, to as long as 14 years after radiotherapy in some patients. 3. The earliest effect of radiotherapy appears to be upon the pulmonary vascular bed in the irradiated region.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available