Hostname: page-component-84b7d79bbc-g7rbq Total loading time: 0 Render date: 2024-08-05T00:56:29.877Z Has data issue: false hasContentIssue false
  • English
  • Français

Estimating the risk of lung cancer and cardiac mortality from doses to the lung and heart from modern tangent-only breast radiotherapy

Published online by Cambridge University Press:  05 September 2018

Loukas A. Georgiou  and
Adam F. Farmer
Loukas A. Georgiou*
Affiliation:
Rhodes University, Memphis, TN, USA
Adam F. Farmer
Affiliation:
Carl Kirkland Cancer Center, 620W. Forest Ave., Jackson, TN, USA
*
Author for correspondence: Loukas Georgiou, Rhodes University, Box #1641, 2000 N. Parkway, Memphis, TN 38112, USA. Tel: 17315416250. E-mail: geola-20@rhodes.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose

The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) reported that the risks of breast cancer treatment in woman smokers may outweigh the benefits. The data used doses from published reports using a variety of treatment techniques. In our study, the risks of lung cancer and heart disease were determined from a modern era tangential-only technique.

Methods and materials

Doses to the lung and heart were obtained for tangential radiotherapy to the breast or chest wall. The risk of lung cancer incidence and cardiac mortality were calculated by taking the ratio of our doses to those published by the EBCTG.

Results

A total of 77 women were identified meeting our inclusion criteria. The mean combined whole lung dose was 2·0 Gy. The mean whole heart dose was 0·9 Gy. The estimated risk of lung cancer and cardiac mortality in a 50-year-old life-long smoker was estimated to be 1·5 and <1%, respectively.

Conclusions

Tangential only radiotherapy delivered substantially lower doses to the combined whole lung and whole heart than those reported by the EBCTCG. In this cohort, the risks of radiation induced lung cancer and heart disease are outweighed by the benefits of radiotherapy even in those that are smokers.

Keywords

breast cancercardiac risklung cancer risktangential radiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 17 , Issue 3 , September 2018 , pp. 260 - 265
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Fisher, B, Anderson, S, Bryant, J et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N En J Med 2002; 347 (16): 1233–1241.Google Scholar
2. Veronesi, U, Cascinelli, N, Mariani, L et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347 (16): 1227–1232.Google Scholar
3. Jacobsen, J A, Danforth, D N, Cowan, K H et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 1995; 332 (14): 907–911.Google Scholar
4. Early Breast Cancer Trialists’ Collaborative Group (EBCTG), Darby, S, McGale, P et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10, 801 women in 17 randomised trials. Lancet 2011; 378 (9804): 1707–1716.Google Scholar
5. Overgaard, M, Jensen, M, Overgaard, J et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Brest Cancer Cooperative Group DBCG 82c randomised trial. Lancet 1999; 353 (9165): 1641–1648.Google Scholar
6. Overgaard, M, Hansen, P S, Overgaard, J et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 1997; 337 (14): 949–955.Google Scholar
7. Recht, A, Edge, S B, Solin, L J et al. Post-mastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001; 19 (5): 1539–1569.Google Scholar
8. Whelan, T, Olivetto, I A, Parulekar, W R et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med 2015; 373 (4): 307–316.Google Scholar
9. Poortmans, P M, Collette, S, Kirklove, C et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 2015; 373 (4): 317–327.Google Scholar
10. Clark, M, Collins, R, Darby, S et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366 (9503): 2087–2106.Google Scholar
11. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), McGale, P, Taylor, C et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 2014; 383 (9935): 2127–2135.Google Scholar
12. Budach, W, Bolke, E, Kammers, K, Gerber, P A, Nestle-Kramling, C, Matuschek, C. Adjuvant radiation therapy of regional lymph nodes in breast cancer – a meta-analysis of randomized trials – an update. Radiat Oncol 2015; 10: 258.Google Scholar
13. Inskip, P D, Stoval, M, Flannery, J T. Lung cancer risk and radiation dose among women treated for breast cancer. J Natl Cancer Inst 1994; 86 (13): 983–988.Google Scholar
14. Lorigan, P, Radford, J, Howell, A, Thatcher, N. Lung cancer after treatment for Hodgkin’s Lymphoma: a systematic review. Lancet Oncol 2005; 6 (10): 773–779.Google Scholar
15. Ibrahim, E M, Kazkaz, G A, Abouelkhair, K M et al. Increased risk of second lung cancer in Hodgkin’s Lymphoma survivors: a meta-analysis. Lung. 2013; 191 (1): 117–134.Google Scholar
16. Gilbert, E S, Stovall, M, Gospodarowicz, M et al. Lung cancer after treatment for Hodgkin’s disease: focus on radiation effects. Radiat Res 2003; 159 (2): 161–173.Google Scholar
17. Grantzau, T, Thomsen, M S, Veath, M, Overgaard, J. Risk of second primary lung cancer in women after radiotherapy for breast cancer. Radiother Oncol 2014; 111 (3): 366–373.Google Scholar
18. Sardar, P, Kundu, A, Chattarjee, S et al. Long-term cardiovascular mortality after radiotherapy for breast cancer: a systematic review and meta-analysis. Clin Cardiol 2017; 40 (2): 73–81.Google Scholar
19. Darby, S C, McGale, P, Taylor, C W, Peto, R. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER registries. Lancet Oncol 2005; 6 (8): 557–565.Google Scholar
20. Prochazka, M, Hall, P, Gagliardi, G et al. Ionizing radiation and tobacco use increases the risk of subsequent lung carcinoma in women with breast cancer: case-only design. J Clin Oncol 2005; 23 (30): 7467–7474.Google Scholar
21. Taylor, C, Correa, C, Duane, F K et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart from previous randomized trials. J Clin Oncol 2017; 35 (15): 1641–1649.Google Scholar
22. https://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx. Accessed on 17th July 2018.Google Scholar
23. Taylor, C, Correa, C, Duane, F K et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart from previous randomized trials. J Clin Oncol 2017; 35 (15): 1641–1649.Google Scholar
24. Hendry, J H, Niwa, O, Barcellos-Hoff, M H, et al. ICRP publication 131: stem cell biology with respect to carcinogenesis aspects of radiological protection. Ann ICRP 2016; 45 (suppl 1): 239–252.Google Scholar
25. Burtt, J J, Thompson, P A, Lafrenie, R M. Non-targeted effects and radiation-induced carcinogenesis: a review. J Radiol Prot 2016; 36 (1): R23–R35.Google Scholar
26. DeSantis, C E, Fedewa, S A, Goding Sauer, A, Kramer, J L, Smith, R A, Jemal, A. Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin 2016; 66 (1): 31–42.Google Scholar
27. Njorc, S, Nystrom, L, Moss, S et al. Breast cancer mortality in mammographic screening in Europe: a review of incidence-based mortality studies. J Med Screen 2012; 19 (suppl 1): 33–41.Google Scholar
28. Taylor, C W, Wang, Z, Macaulay, E, Jagsi, R, Duane, F, Darby, S C. Exposure of the heart in breast cancer radiation therapy: a systematic review of heart doses published during 2003 to 2013. Int J Radiat Oncol Biol Phys 2015; 93 (4): 845–853.Google Scholar