Long-term risks of secondary cancer for various whole and partial breast irradiation techniques

For early stage breast cancer patients, non-breast cancer mortality including secondary cancers and cardiac events can overshadow the benefit of adjuvant radiotherapy. This study evaluates the excess risk of secondary cancer for various breast radiotherapy techniques including accelerated partial br...

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Bibliographic Details
Published in:	Radiotherapy and oncology Vol. 128; no. 3; pp. 428 - 433
Main Authors:	Hoekstra, Nienke, Fleury, Emmanuelle, Merino Lara, Tomas Rodrigo, van der Baan, Peter, Bahnerth, Andy, Struik, Gerson, Hoogeman, Mischa, Pignol, Jean-Philippe
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier B.V 01-09-2018
Subjects:	Accelerated partial breast irradiation Adult Aged Aged, 80 and over Brachytherapy - adverse effects Breast cancer Breast Neoplasms - epidemiology Breast Neoplasms - radiotherapy Databases, Factual Female Humans Imaging, Three-Dimensional Lung Neoplasms - epidemiology Lung Neoplasms - etiology Middle Aged Neoplasms, Radiation-Induced - epidemiology Neoplasms, Radiation-Induced - etiology Neoplasms, Second Primary - epidemiology Neoplasms, Second Primary - etiology Phantoms, Imaging Radiation Dosage Radiosurgery - adverse effects Radiotherapy techniques Radiotherapy, Adjuvant - adverse effects Radiotherapy, Adjuvant - methods Radiotherapy, Conformal - adverse effects Radiotherapy, Conformal - methods Risk Assessment - methods Scatter doses Secondary cancer United States - epidemiology Accelerated partial breast irradiation Radiotherapy techniques Scatter doses Breast cancer Secondary cancer
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Summary:	For early stage breast cancer patients, non-breast cancer mortality including secondary cancers and cardiac events can overshadow the benefit of adjuvant radiotherapy. This study evaluates the excess risk of secondary cancer for various breast radiotherapy techniques including accelerated partial breast irradiation (APBI). Secondary cancers Lifetime Attributable Risks (LAR) were calculated using a modified BEIR-VII formalism to account for the specific survival of breast cancer patients. Those survivals were extracted from the SEER database. Doses scattered to various organs were measured into a Rando phantom with custom-made breast phantoms. Treatments delivered typical doses of brachytherapy APBI (34 Gy in 10 fractions), external beam APBI (38.5 Gy in 10 fractions) using 3D-conformal, Cyberknife stereotactic (CK), or VMAT, as well as whole breast irradiation (WBI) delivering 42.5 Gy in 16 fractions. WBI resulted in the highest total LAR, with 4.3% excess risk of secondary cancer for a patient treated at age 50 years. Lung cancers accounted for 75–97% of secondary malignancies. For a typical early stage patient irradiated at 50, the excess risks of secondary lung cancer were 1.1% for multicatheter HDR, between 2.2% and 2.5% for 3D-CRT or CK, 3.5% for VMAT APBI, and 3.8% for WBI. APBI reduces the risk of secondary cancer 2–4 fold compared to WBI. These techniques are well suited for long-living early stage breast cancer patients. HDR brachytherapy and 3D-conformal APBI achieve mean lung doses between 1 and 1.5 Gy, which could serve as reference.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0167-8140 1879-0887
DOI:	10.1016/j.radonc.2018.05.032