Dataset Information

Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010-2015.

ABSTRACT:

Background and purpose

We report a systematic review of lung radiation doses from breast cancer radiotherapy.

Methods and materials

Studies describing breast cancer radiotherapy regimens published during 2010-2015 and reporting lung dose were included. Doses were compared between different countries, anatomical regions irradiated, techniques and use of breathing adaptation.

Results

471 regimens from 32 countries were identified. The average mean ipsilateral lung dose (MLD_ipsi) was 9.0?Gy. MLD_ipsi for supine radiotherapy with no breathing adaption was 8.4?Gy for whole breast/chest wall (WB/CW) radiotherapy, 11.2?Gy when the axilla/supraclavicular fossa was irradiated, and 14.0?Gy with the addition of internal mammary chain irradiation; breathing adaptation reduced MLD_ipsi by 1?Gy, 2?Gy and 3?Gy respectively (p?ipsi was lowest for tangents in prone (1.2?Gy) or lateral decubitus (0.8?Gy) positions. The highest MLD_ipsi was for IMRT in supine position (9.4?Gy). The average mean contralateral lung dose (MLD_cont) for WB/CW radiotherapy was higher for IMRT (3.0?Gy) than for tangents (0.8?Gy).

Conclusions

Lung doses from breast cancer radiotherapy varied substantially worldwide, even between studies describing similar regimens. Lymph node inclusion and IMRT use increased exposure, while breathing adaptation and prone/lateral decubitus positioning reduced it.

SUBMITTER: Aznar MC

PROVIDER: S-EPMC5807032 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Publications

Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010-2015.

Aznar Marianne C MC Duane Frances K FK Darby Sarah C SC Wang Zhe Z Taylor Carolyn W CW

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 20171212 1

<h4>Background and purpose</h4>We report a systematic review of lung radiation doses from breast cancer radiotherapy.<h4>Methods and materials</h4>Studies describing breast cancer radiotherapy regimens published during 2010-2015 and reporting lung dose were included. Doses were compared between different countries, anatomical regions irradiated, techniques and use of breathing adaptation.<h4>Results</h4>471 regimens from 32 countries were identified. The average mean ipsilateral lung dose (MLD<s ...[more]

PMID: 29246585

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Project description:Purpose Radiotherapy reduces the absolute risk of breast cancer mortality by a few percentage points in suitable women but can cause a second cancer or heart disease decades later. We estimated the absolute long-term risks of modern breast cancer radiotherapy. Methods First, a systematic literature review was performed of lung and heart doses in breast cancer regimens published during 2010 to 2015. Second, individual patient data meta-analyses of 40,781 women randomly assigned to breast cancer radiotherapy versus no radiotherapy in 75 trials yielded rate ratios (RRs) for second primary cancers and cause-specific mortality and excess RRs (ERRs) per Gy for incident lung cancer and cardiac mortality. Smoking status was unavailable. Third, the lung or heart ERRs per Gy in the trials and the 2010 to 2015 doses were combined and applied to current smoker and nonsmoker lung cancer and cardiac mortality rates in population-based data. Results Average doses from 647 regimens published during 2010 to 2015 were 5.7 Gy for whole lung and 4.4 Gy for whole heart. The median year of irradiation was 2010 (interquartile range [IQR], 2008 to 2011). Meta-analyses yielded lung cancer incidence ? 10 years after radiotherapy RR of 2.10 (95% CI, 1.48 to 2.98; P < .001) on the basis of 134 cancers, indicating 0.11 (95% CI, 0.05 to 0.20) ERR per Gy whole-lung dose. For cardiac mortality, RR was 1.30 (95% CI, 1.15 to 1.46; P < .001) on the basis of 1,253 cardiac deaths. Detailed analyses indicated 0.04 (95% CI, 0.02 to 0.06) ERR per Gy whole-heart dose. Estimated absolute risks from modern radiotherapy were as follows: lung cancer, approximately 4% for long-term continuing smokers and 0.3% for nonsmokers; and cardiac mortality, approximately 1% for smokers and 0.3% for nonsmokers. Conclusion For long-term smokers, the absolute risks of modern radiotherapy may outweigh the benefits, yet for most nonsmokers (and ex-smokers), the benefits of radiotherapy far outweigh the risks. Hence, smoking can determine the net effect of radiotherapy on mortality, but smoking cessation substantially reduces radiotherapy risk.

Project description:BackgroundWomen with early breast cancer who meet guideline-based criteria should be offered breast conserving surgery (BCS) with adjuvant radiotherapy as an alternative to mastectomy. New Zealand (NZ) has documented ethnic disparities in screening access and in breast cancer treatment pathways. This study aimed to determine whether, among BCS-eligible women, rates of receipt of mastectomy or radiotherapy differed by ethnicity and other factors.MethodsThe study assessed management of women with early breast cancer (ductal carcinoma in situ [DCIS] and invasive stages I-IIIA) registered between 2010 and 2015, extracted from the recently consolidated New Zealand Breast Cancer Registry (now Te Rēhita Mate Ūtaetae NZBCF National Breast Cancer Register). Specific criteria were applied to determine women eligible for BCS. Uni- and multivariable analyses were undertaken to examine differences by demographic and clinicopathological factors with a primary focus on ethnicity (Māori, Pacific, Asian, and Other; the latter is defined as NZ European, Other European, and Middle Eastern Latin American and African).ResultsOverall 22.2% of 5520 BCS-eligible women were treated with mastectomy, and 91.1% of 3807 women who undertook BCS received adjuvant radiotherapy (93.5% for invasive cancer, and 78.3% for DCIS). Asian ethnicity was associated with a higher mastectomy rate in the invasive cancer group (OR 2.18; 95%CI 1.72-2.75), compared to Other ethnicity, along with older age, symptomatic diagnosis, advanced stage, larger tumour, HER2-positive, and hormone receptor-negative groups. Pacific ethnicity was associated with a lower adjuvant radiotherapy rate, compared to Other ethnicity, in both invasive and DCIS groups, along with older age, symptomatic diagnosis, and lower grade tumour in the invasive group. Both mastectomy and adjuvant radiotherapy rates decreased over time. For those who did not receive radiotherapy, non-referral by a clinician was the most common documented reason (8%), followed by patient decline after being referred (5%).ConclusionRates of radiotherapy use are high by international standards. Further research is required to understand differences by ethnicity in both rates of mastectomy and lower rates of radiotherapy after BCS for Pacific women, and the reasons for non-referral by clinicians.

Dataset Information

Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010-2015.

Background and purpose

Methods and materials

Results

Conclusions

Publications

Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010-2015.

Similar Datasets

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