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

Published:March 25, 2019DOI:


      • 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.



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


      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.


      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.


      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.


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