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Common complications of thoracic radiotherapy include esophagitis and radiation pneumonitis. However, it is important to be aware of uncommon post-radiotherapy complications such as bronchiolitis obliterans organizing pneumonia (BOOP). We report on two patients with carcinoma of the breast who developed an interstitial lung disease consistent with BOOP. BOOP responds to treatment with corticosteroids and the prognosis is generally good despite of the need for longterm administration of corticosteroids as relapses can occur during tapering of steroids. This report provides guidelines for the evaluation and treatment of patients with pulmonary infiltrates after radiotherapy. Background Radiation pneumonitis and fibrosis are well-recognized complications of thoracic radiotherapy, but less common complications include Bronchiolitis Obliterans Organizing Pneumonia (BOOP) and eosinophilic pneumonia [1]. It is also not commonly appreciated that these complications can manifest in patients receiving radiotherapy for breast cancer. We report two such patients who developed a BOOP following post-operative radiotherapy to the thoracic wall. The clinical features, diagnostic considerations, and treatment of interstitial lung disease following radiotherapy will serve to alert clinicians to this clinical entity and provide guidelines for diagnostic workup. Case report Patient no.1 A 59-year-old female who was a lifelong non-smoker underwent a modified radical mastectomy in August 2002 for an adenocarcinoma of her left breast, staged pT2N2M0. Adjuvant chemotherapy consisting of 4 cycles of doxorubicin (60 mg/m2) with cyclofosfamide (600 mg/ m2) was administered from September to November 2002, followed by tamoxifen 20 mg daily. The patient was then referred for adjuvant radiotherapy on the left thoracic wall and the axillary lymph nodes. After CT planning, she received radiation from 6th February to 20th March 2003 to a total dose of 50 Gy in 25 fractions. The thoracic wall was irradiated using tangential 6 Mv photon fields, and regional lymph nodes using an anterior-postePublished: 03 January 2007 Radiation Oncology 2007, 2:2 doi:10.1186/1748-717X-2-2 Received: 22 August 2006 Accepted: 03 January 2007 This article is available from: http://www.ro-journal.com/content/2/1/2 © 2007 Cornelissen et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.