Abstract and Introduction
Post-radiotherapy bronchiolitis obliterans organizing pneumonia may occur in as many as 2.3% of women receiving radiation therapy for breast cancer. Cough and fever are common symptoms, and a quarter of these women have no symptoms. Latency period is usually within 6 months after completion of therapy but may be as long as 1 year. Pulmonary function is normal or will show slight decreases in vital capacity and diffusing capacity. Chest computed tomography studies show ground-glass opacities with air bronchograms within and outside the radiation field, and there are often peripheral triangular-shaped infiltrates. Management consists of close monitoring of women who have no symptoms or minimal symptoms, and a short-course of corticosteroid therapy for women who have symptoms and extensive bronchiolitis obliterans organizing pneumonia. The prognosis is excellent; there have been no deaths reported.
Bronchiolitis obliterans organizing pneumonia (BOOP) is an inflammatory lung disease showing swirls of polypoid plugs of granulation tissue involving the distal bronchioles, bronchiolar ducts and alveoli, and without disruption of the lung architecture. This lesion may occur as an idiopathic process, associated with systemic disorders, or secondary to medications or chest radiation therapy. The term organizing pneumonia has been suggested for BOOP because the process is predominately alveolar; however, the term BOOP is used in this report because the lesions related to breast cancer radiation appear histologically to include the bronchial airways and are consistent with the histologic description of BOOP. The BOOP lesion has also been referred to as Epler's pneumonia. This report will describe the historic perspective, clinical findings, chest imaging features and treatment of post-breast cancer radiotherapy BOOP.