Abstract

Background: Breast cancer remains the most prevalent cancer among women, with a significant number of Indian patients being premenopausal and aged between 40–50 years. Radiotherapy plays a vital role in breast cancer treatment but may lead to pulmonary toxicity, including radiation pneumonitis (RP) and radiation fibrosis (RF), particularly in the lung tissue which is a critical organ at risk. Objective: This study aims to assess pulmonary toxicity following post-operative hypofractionated radiotherapy using conventional 2D techniques in breast cancer patients. It specifically evaluates the incidence of RP and RF, correlates clinical and radiological findings, and analyzes associations with treatment-related factors. Methods: A prospective observational study was conducted from March 2023 to March 2025 at the Department of Radiation Oncology, S.N. Medical College, Agra. Eligible post-mastectomy and breast conserving surgery patients receiving adjuvant hypofractionated radiotherapy (40 Gy in 15 fractions over 3 weeks) using conventional 2D techniques were enrolled. Baseline pulmonary function tests (PFTs), clinical assessments, chest radiographs, and simulation measurements (CLD, MLD, SLD, ILD) were recorded pre-treatment, and at 3 and 6 months posttreatment. CT imaging and PFTs (FEV1, FVC, TLC) will be used to assess RP and RF. Lung toxicity was graded using ATS criteria.

• 1.   Globacon cancer observatory https://gco.iarc. fr/en.
• 2.   Perez & Brady’s Principles and Practice of Radiation Oncology.
• 3.   The cancer genome Atlas.
• 4.   Global Cancer Observatory, IARC-WHO, 2022.
• 5.   JNCI: Journal of the National Cancer Institute, Volume 50, Issue 1, January 1973, Pages 21–42, https://doi.org/10.1093/jnci/50.1.21.
• 6.   Jeba J., Isiah R., Subhashini J., Backianathan S., Thangakunam B., Christopher D.J. Radiation Pneumonitis After Conventional Radiotherapy For Breast Cancer: A Prospective Study. J Clin Diagn Res. 2015 Jul; 9(7): XC01-XC05.
• 7.   Shaaban L., Elkholy M., Abbas H. Pulmonary toxicity of postoperative adjuvant chemoradiotherapy for breast cancer. Egypt J Chest Dis Tuberc 2010; 4: 59–63.
• 8.   Rastogi K., Jain S., Bhatnagar A.R., Bhaskar S., Gupta S., Sharma N. A comparative study of hypofractionated and conventional radiotherapy in postmastectomy breast cancer patients. Asia Pac J Oncol Nurs 2018; 5: 107–13.
• 9.   Lingos, A. Recht, F. Vicini, A. Abner, B. Silver, JR Harris. Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1991; 21: 355–60.
• 10.   Shaltout E.A., El Razek A. Adjuvant postmastectomy hypofractionated radiotherapy in Egyptian cancer patients: A 2 years follow-up. Ann Oncol 2012; 23: 34–6.
• 11.   Plataniotis G. Hypofractionated radiotherapy in the treatment of early breast cancer. World J Radiol. 2010 Jun 28; 2(6): 197-202. doi: 10.4329/ wjr.v2.i6.197. PMID: 21160631; PMCID: PMC2999325.

Data Sharing Statement

Funding