Am. J. Respir. Crit. Care Med., Volume 158, Number 6, December 1998, 1929-1935

Bronchiolitis Obliterans Organizing Pneumonia Syndrome Primed by Radiation Therapy to the Breast

BRUNO CRESTANI, DOMINIQUE VALEYRE, SERGE RODEN, BENOÎT WALLAERT, JEAN-CHARLES DALPHIN, JEAN-FRANÇOIS CORDIER, and the Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM"O"P)

Unité de Pneumologie, Hôpital Bichat, Paris; Service de Pneumologie, Hôpital Avicenne, Bobigny; Centre Spécialisé en Pneumologie, Chevilly-Larue; Clinique des Maladies Respiratoires, Hôpital Calmette, Lille; Service de Pneumologie, Centre Hospitalier Régional, Besançon; and Service de Pneumologie, Hôpital Louis Pradel, Lyon, France

Reports of bronchiolitis obliterans organizing pneumonia (BOOP) occurring in women after radiation therapy for breast cancer have suggested that radiation to the lung could participate in the development of BOOP. We now describe the clinical, radiographic, functional, and bronchoalveolar lavage characteristics of this syndrome in a series of 15 patients reported to the Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P) in France. All 15 women (60 ± 6 yr of age) fulfilled the following inclusion criteria: (1) radiation therapy to the breast within 12 mo, (2) general and/or respiratory symptoms lasting for at least 2 wk, (3) lung infiltrates outside the radiation port, and (4) no specific cause. The patients presented with fever, nonproductive cough, mild dyspnea, and peripheral alveolar opacities on chest radiograph with a characteristic migratory pattern. In five patients, BOOP was found at lung pathologic analysis. In all the patients dramatic improvement was obtained with corticosteroids, but relapses occurred in 12 patients while tapering or after stopping corticosteroids. This report demonstrates that a characteristic BOOP syndrome may occur after radiation therapy to the breast, including tangential radiation to the lung, thus suggesting that radiation therapy may prime the development of BOOP.

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