International Journal of Hematology and Oncology 2022, Vol 32, Num 3 Page(s): 159-165
The Influence of Hormone Therapy on the Development of Pulmonary Fibrosis after Radiotherapy in Patients with Breast Cancer

Berrin BENLI YAVUZ1, Necdet POYRAZ2, Gul KANYILMAZ1, Meryem AKTAN1, Ismail H. TUNCEZ3, Mehmet KOC1

1Necmettin Erbakan University, Meram Faculty of Medicine, Department of Radiation Oncology, Konya, TURKIYE
2Necmettin Erbakan University, Meram Faculty of Medicine, Department of Radiology, Konya, TURKIYE
3Konya Provincial Health Directorate, Department of Public Health and Biostatistics, Konya, TURKIYE

Keywords: Breast cancer, Tamoxifen, Aromatase inhibitors, Pulmonary fibrosis
The aim of the present study is to investigate the effects of hormone therapy on pulmonary fibrosis in patients who received curative conformal radiotherapy for breast cancer. Data of 469 patients were evaluated. Computerized tomography images were evaluated by a radiologist as blindly. The influence of hormone therapy (tamoxifen and aromatase inhibitors), age, menopause, radiotherapy fields, ipsilateral lung volume receiving 5 Gy (V5), ipsilateral lung volume receiving 20 Gy (V20), ipsilateral mean lung dose (MLD) and the effects of taxane group of chemotherapy on pulmonary fibrosis were investigated. The mean age was 51 (range 27-83) years. As hormone therapy, 159 patients (33.9%) used tamoxifen and 253 patients (53.9%) used aromatase inhibitors. A significant relationship was found between both 6th month lung fibrosis and 2nd year lung fibrosis, and V5, V20, MLD, regional lymphatic irradiation and hormone therapy use. More grade 2 fibrosis was detected in the patients who received tamoxifen compared to the patients who received aromatase inhibitors and the control group (p< 0.001). No association was found between menopausal status, age, and taxane group chemotherapy and lung fibrosis development. In multivariate analysis, V5, MLD, and using hormone therapy were shown to be independent predictors of the risk of developing fibrosis at both 6 months and 2 years. Use of tamoxifen increases early and late lung fibrosis more than aromatase inhibitors in patients who receive radiotherapy for breast cancer. However, V5, V20, MLD and regional lymph node irradiation also contribute to the prevalence of fibrosis.