RÉSUMÉ
PURPOSE: To investigate development of radiation pneumonitis (RP) in relation to pulmonary function, dosimetric factors, and transforming growth factor beta-1 (TGFß1) expression in irradiated breast cancer patients. METHODS: A total of 49 breast cancer patients who received post-operative radiotherapy (RT) were evaluated in terms of pulmonary function tests (PFTs), quality of life (QoL), development of RP, dosimetric factors, cytokine levels, and lung high-resolution computed tomography (HRCT) before and after RT. ROC analysis was performed for performance of dosimetric factors in predicting RP, while frequencies of single nucleotide polymorphisms (SNPs) genotyped for TGFß1 (rs11466345 and rs1800470) were also evaluated. RESULTS: All cases with RP (10.2%) recovered clinically at the end of third post-RT month. PFT and HRCT parameters were similar before and after RT overall, as well as by RP and the radiation field subgroups. ROC analysis revealed the significant role of the ipsilateral V5 (cutoff value of 45.9%, p = 0.039), V10 (29.4%, p = 0.015), V20 (23%, p = 0.017), and MLD (1200 cGy, p = 0.030) in predicting RP. Higher post-RT TGFß1 levels (p = 0.037) were noted overall and in patients with RP. Patient and control groups were similar in terms of frequencies of SNPs genotyped for TGFß1 (rs11466345 and rs1800470). EORTC QLQ-C30 and QLQ-BR-23 scores were similar in patients with vs. without RP. CONCLUSION: Our findings revealed significant role of dosimetric factors including MLD, V20 as well as the low dose-volume metrics in predicting the risk of RP among breast cancer patients who received post-operative RT. Implementation of RT, extent of radiation field or the presence of RP had no significant impact on PFTs.
Sujet(s)
Tumeurs du sein , Poumon , Poumon radique , Radiothérapie adjuvante , Femelle , Humains , Tumeurs du sein/génétique , Tumeurs du sein/radiothérapie , Tumeurs du sein/chirurgie , Études de suivi , Poumon/physiopathologie , Poumon/effets des radiations , Polymorphisme de nucléotide simple , Études prospectives , Qualité de vie , Poumon radique/étiologie , Poumon radique/génétique , Poumon radique/physiopathologie , Dosimétrie en radiothérapie , Radiothérapie adjuvante/effets indésirables , Tests de la fonction respiratoireRÉSUMÉ
Acute respiratory distress syndrome (ARDS) as a complication of malaria infection is rare but with a very high mortality rate. We report the case of a patient who developed high fever, then respiratory distress during a trip to Haiti who was admitted to our hospital and diagnosed with malaria. During recovery the patient developed ARDS in the hospital.