Pleural-based changes on chest x-ray after irradiation for primary breast cancer: correlation with findings on computerized tomography

In treating breast cancer with excisional biopsy and irradiation, a volume of lung underlying the breast and chest wall receives significant doses of irradiation. This irradiation can produce pleural and pulmonary changes that can be seen on routine chest radiographs. In five such cases, we have examined pre and post-treatment computerized tomograms of the chest and show that these radiographic changes are pleural-based and lie within the high dose radiation volume. Failure to correct radiation treatment plans for the influence of lung density results in an increased dose to lung and pleura that could, in theory, exacerbate pulmonary and pleural radiation effects