الفهرس 
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Abstract
The current study was carried out on 45 subjects who were devided into 2main groups. The control group (group I) which included 15 apparently normal healthy control females free from any lung disease. The breast cancer patients’ group (group II) which included 30 breast cancer female patients (clinical stages II and III) who already underwent surgery (modified radical mastectomy or conservative surgery). These patients were subdivided into two subgroups: subgroup IIA which consisted of 15 breast cancer patients that were treated with postoperative radiotherapy using 3D-CRT plan and subgroup IIB which consisted of 15 breast cancer patients that were treated with postoperative radiotherapy using IMRT plan.
The aim of the current study was to evaluate and compare the early lung toxicity induced by3D-CRT and IMRT radiotherapy treatment modalities in breast cancer female patients using biochemical, dosimetric and clinical data.
Patients were subjected to computed tomography (CT)- scanning pre-exposure to radiotherapy, immediately after termination of radiotherapy and after 3 months of radiotherapy to detect early occurrence of radiation pneumonitis to be correlated with the serum levels of the studied lung toxicity markers which were IL-6 and SP-D.
Three blood samples were collected from cancer patients before RT, immediately after RT and after 3 months of completion of RT. One blood sample was obtained from the control group. Blood samples were used to separate sera on which biochemical analysis were performed. Serum levels of IL-6 and pulmonary surfactant D were measured in all studied groups using ready- for- use ELISA kits according to manufacturer’s protocol.
Regarding age distribution among the control group and breast cancer group,the statistical analysis of the results shown in table (4-2) revealed that there was a non- significant difference between the mean age of controls and the mean age of breast cancer
patients (p=0.642).This means that the breast cancer patients and the control subjects included in the current study were matched with each other with respect to their age
With respect to menopausal status distribution among the control group and breast cancer group, the statistical analysis of the results shown in table (4.3) revealed that there was a non-significant difference between the controls and the breast cancer patients with respect to menopausal status distribution among them (p=0.537). this means that there was a similarity in the distribution of the menopausal status between the breast cancer patients’ group and control group.
Regarding the levels of serum IL-6 in the control group and breast cancer patients subgroups treated with either 3D-CRT plan or IMRT plan, the statistical analysis of the results shown in tables (4.4 & 4.5) revealed a non-significant increase in the serum levels of IL-6 before RT compared with its levels in the control group (p=0.401,p= 0.505, respectively).This means that treatment of the breast cancer patients included in the current study with chemotherapy did not produce a toxic effect on their lungs.
Regarding the effect of radiotherapy (either 3D-CRT plan or IMRT plan) on the serum levels of IL-6 in breast cancer patients, the results shown in table (4.4&4.5) revealed that there was a significant increase in serum levels of IL-6 after RT compared with its levels before RT (p=0.039*,0.046*; respectively) and compared with its levels in the control group (p=0.03*,0.04*; respectively).
Regarding the serum levels of IL-6 three months after radiotherapy using 3D-CRT plan, the results illustrated in table (4.4) mean that there was a non-significant decrease in the serum levels of IL-6 three months after radiotherapy compared with its serum levels immediately after RT (p=0.173). On the other hand, the results outlined in table (4.5) revealed that there was a significant decrease in the serum levels of the IL-6 after three months of radiotherapy using IMRT plan compared with its values directly after finishing radiotherapy course (p=0.013*) which was still within the same levels of the control group (p=0.369). The results of the current study indicated that the radiation toxicity induced in the lungs immediately after terminating radiotherapy course was recovered in case of using IMRT plan.
With respect to the levels of serum SP-D in the control group and breast cancer patient’s subgroups treated with either 3D-CRT plan or IMRT plan, the statistical analysis of the results shown in table (4.6&4.7) revealed a non-significant increase in the serum levels of SP-D before RT compared with its levels in the control group (p=0.339, p=0.369; respectively).
Regarding the effect of radiotherapy on the serum levels of SP-D in breast cancer patients subgroups treated with either 3D-CRT plan or IMRT plan, the results shown in table (4.6&4.7) revealed that there was a significant increase in serum levels of SP-D after RT compared with its levels before RT (p=0.028*, p=0.009* respectively) and compared with its levels in the control group (p=0.026*, p=0.004* respectively).
Regarding the serum levels of SP-D three months after radiotherapy using 3D-CRT plan, the results illustrated in table (4.6) mean that there was a non-significant decrease in the serum levels of SP-D three months after radiotherapy compared with its serum levels immediately after RT (p=0.07). On the other hand, the results shown in table (4.7) revealed that there was significant decrease in the serum levels of SP-D three months after radiotherapy using IMRT plan compared with its serum levels directly after terminating radiotherapy course (p=0.005*). The results of the current study indicated that the radiation toxicity induced in the lungs immediately after terminating radiotherapy course was recovered in case of using IMRT plan.