Advertisement

Risk of contralateral breast and ipsilateral lung cancer induction from forward-planned IMRT for breast carcinoma

Published:March 25, 2019DOI:https://doi.org/10.1016/j.ejmp.2019.03.021

      Highlights

      • Second cancer risks were assessed using patient-specific data and a mechanistic model.
      • fIMRT for breast cancer increases the cancer risks compared to baseline probabilities.
      • Hypofractionated instead of standard fractionated IMRT leads to a reduced cancer risk.

      Abstract

      Purpose

      To assess the risk of contralateral breast and ipsilateral lung cancer induction from forward-planned IMRT for breast carcinoma.

      Methods

      The study group included 13 females irradiated for breast cancer with 6 MV photons. The plans were initially generated by using standard fractionated (SF) forward-planned IMRT (50 Gy at 2 Gy/fraction). Hypofractionated (HF) IMRT (42.56 Gy at 2.66 Gy/fraction) was also employed for plan creation. Differential DVHs derived from the treatment plans were used to estimate the patient-specific organ equivalent dose (OED) to the contralateral breast and ipsilateral lung and the relevant lifetime attributable risks of cancer development. These estimates were made with a non-linear mechanistic model. The radiotherapy-induced cancer risks were combined with the lifetime intrinsic risk (LIR) values for unexposed people to determine the patient- and organ-specific relative risk (RR) for second cancer induction.

      Results

      The OED of the contralateral breast from SF and HF forward-planned IMRT was up to 0.99 and 0.86 Gy, respectively. The corresponding values for the ipislateral lung were 4.15 and 3.66 Gy. The patient-specific RR range for the contralateral breast and ipislateral lung cancer induction following SF forward-planned IMRT was 1.04–1.10 and 1.60–1.81, respectively. The corresponding RRs from hypofractionated treatment were 1.03–1.09 and 1.53–1.73.

      Conclusions

      The treatment of primary breast carcinoma with the use of SF or HF forward-planned IMRT results in increased probabilities for developing secondary malignancies in the healthy contralateral breast or ipsilateral lung compared to the respective LIRs for an unexposed population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Physica Medica: European Journal of Medical Physics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • DeSanctis C.E.
        • Ma J.
        • Golding Sauer A.
        • Newman L.A.
        • Jemal A.
        Breast cancer statistics, 2017, racial disparity in mortality by state.
        CA Cancer J Clin. 2017; 67: 439-448
        • Ferlay J.
        • Steliarova-Foucher E.
        • Lortet-Tieulent J.
        • Rosso S.
        • Coebergh J.W.W.
        • Comber H.
        • et al.
        Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012.
        Eur J Cancer. 2013; 49: 1374-1403
        • Noone A.M.
        • Howlader N.
        • Krapcho M.
        • Miller D.
        • Brest A.
        • Yu M.
        • et al.
        SEER Cancer Statistics Review, 1975–2015.
        National Cancer Institute, Bethesda, MD2018
        • Goyal S.
        • Buchholz T.A.
        • Haffty B.G.
        Breast cancer: Early stage.
        in: Halperin E.C. Wazer D.E. Perez C.A. Brady L.W. Perez and Brady’s principles and practice in radiation oncology. 6th ed. Lippincott Williams & Wilkins, Philadelphia2013: 1044-1139
        • Stovall M.
        • Smith S.A.
        • Langholz B.M.
        • Boice J.D.
        • Shore R.E.
        • Andersson M.
        • et al.
        Dose to the contralateral breast from radiation therapy and risk of second primary breast cancer in the WECARE study.
        Int J Radiat Oncol Biol Phys. 2008; 72: 1021-1030
        • Berrington de Gonzalez A.
        • Curtis R.E.
        • Gilbert E.
        • Berg C.D.
        • Smith S.A.
        • Stovall M.
        • et al.
        Second solid cancers after radiotherapy for breast cancer in SEER cancer registries.
        Br J Cancer. 2010; 102: 220-226
        • Grantzau T.
        • Overgaard J.
        Risk of second non-breast cancer after radiotherapy for breast cancer: a systematic review and meta-analysis of 762,468 patients.
        Radiother Oncol. 2015; 114: 56-65
        • Dumane V.
        • Kuo L.
        • Hong L.
        • Ho A.Y.
        Intensity-modulated radiation therapy for breast cancer.
        in: Bellon J.R. Wong J.S. MacDonald S.M. Ho A.Y. Radiation therapy techniques and treatment planning for breast cancer. Springer, Switzerland2016: 99-118
        • Whelan T.J.
        • Pignol J.P.
        • Levine M.N.
        • Julian J.A.
        • MacKenzie R.
        • Parpia S.
        • et al.
        Long-term results of hypofractionated radiation therapy for breast cancer.
        N Engl J Med. 2010; 362: 513-520
        • Hall E.J.
        Intensity-modulated radiation therapy, protons, and the risk of second cancers.
        Int J Radiat Oncol Biol Phys. 2006; 65: 1-7
        • Dasu A.
        • Toma-Dasu I.
        Models for the risk of secondary cancers from radiation therapy.
        Phys Med. 2017; 42: 232-238
        • Mazonakis M.
        • Damilakis J.
        Cancer risk after radiotherapy for benign diseases.
        Phys Med. 2017; 42: 285-291
        • BEIR
        Health risks from exposure to low levels of ionizing radiation: BEIR-VII, phase 2.
        National Academies Press, Washington, DC2006
        • Bednarz B.
        • Athar B.
        • Xu X.G.
        A comparative study on the risk of second primary cancers in out-of-field organs associated with radiotherapy of localized prostate carcinoma using Monte Carlo-based accelerator and patient models.
        Med Phys. 2010; 37: 1987-1994
        • Kourinou K.M.
        • Mazonakis M.
        • Lyraraki E.
        • Stratakis J.
        • Damilakis J.
        Scattered dose to radiosensitive organs and associated risk for cancer development from head and neck radiotherapy in pediatric patients.
        Phys Med. 2013; 29: 650-655
        • Mazonakis M.
        • Berris T.
        • Lyraraki E.
        • Damilakis J.
        Cancer risk estimates from radiation therapy for heterotopic ossification prophylaxis after total hip arthroplasty.
        Med Phys. 2013; 40101702
        • Dasu A.
        • Toma-Dasu I.
        Dose-effect model for risk-relationship to cell survival parameters.
        Acta Oncol. 2005; 44: 829-835
        • Shuryak I.
        • Hahnfeldt P.
        • Hlatky L.
        • Sachs R.K.
        • Brenner D.J.
        A new view of radiation-induced cancer: integrating short- and long-term processes. Part II: second cancer risk estimation.
        Radiat Environ Biophys. 2009; 48: 275-286
        • Timlin C.
        • Warren D.R.
        • Rowland B.
        • Madkhali A.
        • Loken J.
        • Partridge M.
        • et al.
        3D calculation of radiation-induced second cancer risk including dose and tissue response heterogeneities.
        Med Phys. 2015; 42: 866-876
        • Schneider U.
        • Sumila M.
        • Robotka J.
        Site-specific dose-response relationships for cancer induction from the combined Japanese A-bomb and Hodgkin cohorts for doses relevant to radiotherapy.
        Theor Biol Med Model. 2011; 8: 27
        • Mazonakis M.
        • Tzedakis A.
        • Lyraraki E.
        • Damilakis J.
        Radiation dose and cancer risk to out-of-field and partially in-field organs from radiotherapy for symptomatic vertebral hemangiomas.
        Med Phys. 2016; 43: 1841-1848
        • Mazonakis M.
        • Lyraraki E.
        • Tzedakis A.
        • Damilakis J.
        Radiotherapy for non-malignant shoulder syndrome: Is there a risk for radiation-induced carcinogenesis?.
        Phys Med. 2017; 53: 73-78
        • Geng C.
        • Moteabbed M.
        • Xie Y.
        • Schuemann J.
        • Yock T.
        • Paganetti H.
        Assessing the radiation-induced second cancer risk in proton therapy for pediatric brain tumors: the impact of employing a patient-specific aperture in pencil beam scanning.
        Phys Med Biol. 2016; 61: 12-22
        • Mazonakis M.
        • Lyraraki E.
        • Damilakis J.
        Second cancer risk assessments after involved-site radiotherapy for mediastinal Hodgkin lymphoma.
        Med Phys. 2017; 44: 3866-3874
        • Knausl B.
        • Lutgendorf-Caucig C.
        • Hopfgartner J.
        • Dieckmann K.
        • Kurch L.
        • Pelz T.
        • et al.
        Can treatment of pediatric Hodgkin’s disease be improved by PET imaging and proton therapy?.
        Strahlenther Onkol. 2013; 189: 54-61
        • Murray L.J.
        • Thompson C.M.
        • Lilley J.
        • Cosgrove V.
        • Franks K.
        • Sebag-Montefiore D.
        • et al.
        Radiation-induced second primary cancer risks from modern external beam radiotherapy for early prostate cancer: impact of stereotactic ablative radiotherapy (SABR), volumetric modulated arc therapy (VMAT) and flattening filter free (FFF) radiotherapy.
        Phys Med Biol. 2015; 60: 1237-1257
        • Schneider U.
        • Stipper A.
        • Besserer J.
        Dose-response relationship for lung cancer induction at radiotherapy dose.
        Z Med Phys. 2010; 20: 206-214
        • Schneider U.
        • Sumila M.
        • Robotka J.
        • Gruber G.
        • Mack A.
        • Besserer J.
        Dose-response relationship for breast cancer induction at radiotherapy dose.
        Radiat Oncol. 2011; 6: 67
        • Arias E.
        • Heron M.
        • Xu J.
        United States life tables, 2014.
        Natl Vital Stat Rep. 2017; 66: 1-64
        • Athiyaman H.
        • Athiyaman M.
        • Chougule A.
        • Hs K.
        Estimated risk of radiation-induced contra lateral breast cancer following chest wall irradiation by conformal wedge field and forward intensity modulated radiotherapy technique for post-mastectomy breast cancer patients.
        Asian Pac J Cancer Prev. 2016; 17: 5107-5111
        • Abo Madyan Y.
        • Aziz M.H.
        • Aly M.
        • Schneider F.
        • Sperk E.
        • Clausen S.
        • et al.
        Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer.
        Radiother Oncol. 2014; 110: 471-476
        • Han E.Y.
        • Paudel N.
        • Sung J.
        • Yoon M.
        • Chung W.K.
        • Kim D.W.
        Estimation of the risk of secondary malignancy arising from whole-breast irradiation: comparison of five radiotherapy modalities, inclunding TomoHDA.
        Oncotarget. 2016; 7: 22960-22969
        • Mazonakis M.
        • Kachris S.
        • Damilakis J.
        Second cancer risk from radiation therapy for common solid tumors diagnosed in reproductive-aged females.
        Radiat Prot Dosimetry. 2018; 182: 208-214