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15.09.2017 | Original Article

Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease

Effects of modern radiotherapy techniques

verfasst von: Dr. med. Stefanie Corradini, Hendrik Ballhausen, Helmut Weingandt, Philipp Freislederer, Stephan Schönecker, Maximilian Niyazi, Cristoforo Simonetto, Markus Eidemüller, Ute Ganswindt, Claus Belka

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 3/2018

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Abstract

Purpose

Modern breast cancer radiotherapy techniques, such as respiratory-gated radiotherapy in deep-inspiration breath-hold (DIBH) or volumetric-modulated arc radiotherapy (VMAT) have been shown to reduce the high dose exposure of the heart in left-sided breast cancer. The aim of the present study was to comparatively estimate the excess relative and absolute risks of radiation-induced secondary lung cancer and ischemic heart disease for different modern radiotherapy techniques.

Methods

Four different treatment plans were generated for ten computed tomography data sets of patients with left-sided breast cancer, using either three-dimensional conformal radiotherapy (3D-CRT) or VMAT, in free-breathing (FB) or DIBH. Dose–volume histograms were used for organ equivalent dose (OED) calculations using linear, linear–exponential, and plateau models for the lung. A linear model was applied to estimate the long-term risk of ischemic heart disease as motivated by epidemiologic data. Excess relative risk (ERR) and 10-year excess absolute risk (EAR) for radiation-induced secondary lung cancer and ischemic heart disease were estimated for different representative baseline risks.

Results

The DIBH maneuver resulted in a significant reduction of the ERR and estimated 10-year excess absolute risk for major coronary events compared to FB in 3D-CRT plans (p = 0.04). In VMAT plans, the mean predicted risk reduction through DIBH was less pronounced and not statistically significant (p = 0.44). The risk of radiation-induced secondary lung cancer was mainly influenced by the radiotherapy technique, with no beneficial effect through DIBH. VMAT plans correlated with an increase in 10-year EAR for radiation-induced lung cancer as compared to 3D-CRT plans (DIBH p = 0.007; FB p = 0.005, respectively). However, the EARs were affected more strongly by nonradiation-associated risk factors, such as smoking, as compared to the choice of treatment technique.

Conclusion

The results indicate that 3D-CRT plans in DIBH pose the lowest risk for both major coronary events and secondary lung cancer.

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Titel: Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease
Effects of modern radiotherapy techniques
verfasst von: Dr. med. Stefanie Corradini
Hendrik Ballhausen
Helmut Weingandt
Philipp Freislederer
Stephan Schönecker
Maximilian Niyazi
Cristoforo Simonetto
Markus Eidemüller
Ute Ganswindt
Claus Belka
Publikationsdatum: 15.09.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 3/2018
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1213-y

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Springer Medizin

Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease

Effects of modern radiotherapy techniques

Abstract

Purpose

Methods

Results

Conclusion

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Abstract

Purpose

Methods

Results

Conclusion

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