Acute radiation pneumonitis after postmastectomy irradiation: effect of fraction size

Clin Oncol (R Coll Radiol). 1990 Jul;2(4):224-9. doi: 10.1016/s0936-6555(05)80173-6.

Abstract

Prior to 1982 the standard radiation tissue absorbed dose administered to the chest wall following mastectomy was 40.0-42.5 Gy in 10 alternate day fractions over 4 weeks. From 1982 the standard maximum dose was 45.0 Gy administered in 20 daily fractions over 4 weeks. On review of the records of the 770 patients treated between 1979 and 1984, 19 (2.5%) had symptoms of acute radiation pneumonitis, 7/484 (1.4%) treated by the earlier technique and 12/286 (4.2%) by the later technique (X2 = 4.56, P less than 0.05). The mean 4 cm depth doses on the chest wall were 33.98 Gy and 36.84 Gy respectively in the earlier and later populations (t = 5.06, P less than 0.001) and 33.62 Gy and 38.30 Gy in those developing acute pneumonitis. Comparison of these two schedules gives an alpha/beta ratio of 8.5 Gy. It is suggested that the sparing of symptomatic acute reactions in human lung by smaller doses per fraction may be less than currently believed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Disease
  • Breast Neoplasms / radiotherapy*
  • Breast Neoplasms / surgery
  • Combined Modality Therapy
  • Female
  • Humans
  • Mastectomy*
  • Pneumonia / etiology*
  • Radiation Injuries*
  • Radiotherapy / adverse effects*
  • Radiotherapy Dosage