Assessment of Radiation-induced Secondary Cancer Risks in Breast Cancer Patients Treated with 3D Conformal Radiotherapy

Document Type : Original Paper

Authors

1 Department of Medical Physics and Medical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

2 Department of Medical Physic, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran.

4 1. Department of Medical Physics and Medical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 4. Radiation Oncology Research Center, Cancer Institute ,Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: In this survey, radiation-induced secondary cancer risks (SCRs) have been assessed in irradiated organs following three-dimensional conformal radiation therapy (3D-CRT) of breast cancer using the Biological Effects of Ionizing Radiation (BEIR) VII models.
Material and Methods: Sixty patients with left-sided breast cancer, who were treated with a total breast dose of 50 Gy in 2 Gy fractions were chosen for this study. Differential dose volume histograms (dDVHs) were retrieved, and values of mean organs dose were computed. Second cancer risks for the heart, ipsilateral lung, liver, thyroid, and contralateral were estimated using both excess relative risk (ERR) and excess absolute risks (EAR) models as proposed by the BEIR VII committee of the U.S National Academy of Sciences.
Results: The mean organ dose values of these 60 patients were 6.8, 15.9, 3.7, 4.5, and 1.5 Gy in the thyroid, ipsilateral lung, contralateral breast, heart, and liver, respectively. Based on the BEIR VII models, ERR was estimated to be 21.2, 5.0, 1.6, and 1.4 Gy-1 for the ipsilateral lung, thyroid, heart, and liver, respectively. In addition, excess absolute risks for cancer incidence were calculated as 105, 45.8, 15.8, and 4.35 Gy-1 for these organs, respectively.
Conclusion: In this survey, SCRs were quantitatively measured for various organs of breast cancer patients who received 3D-CRT. We observed that 3D-CRT treatment was associated with a relatively high SCR in the lung.

Keywords

Main Subjects


  1. Colagiuri B, Christensen S, Jensen AB, Price MA, Butow PN, Zachariae R. Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery. Journal of pain and symptom management. 2011; 42: 710-20.
  2. Group EBCTC. 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. The Lancet. 2005; 366: 2087-106.
  3. Group EBCTC. 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. The Lancet. 2011; 378: 1707-16.
  4. Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al., Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. New England Journal of Medicine. 1997; 337: 949-55.
  5. Overgaard M, Jensen M-B, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. The Lancet. 1999; 353: 1641-8.
  6. McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, 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. Place Elsevier: Elsevier; 2014.
  7. Schneider U, Zwahlen D, Ross D, Kaser-Hotz B. Estimation of radiation-induced cancer from three-dimensional dose distributions: Concept of organ equivalent dose. International Journal of Radiation Oncology* Biology* Physics. 2005; 61: 1510-5.
  8. 8.             Schneider U, Sumila M, Robotka J, Gruber G, Mack A, Besserer J. Dose-response relationship for breast cancer induction at radiotherapy dose. Radiation oncology. 2011; 6: 67.
  9. Burns C, Tuler S, Russ A, Taylor O. Health Risks of Ionizing Radiation: An Overview of Epidemiological Studies: George Perkins Marsh Institute, Clark University; 2006.
  10. Yock TI, Caruso PA. Risk of second cancers after photon and proton radiotherapy: a review of the data. Health physics. 2012; 103: 577-85.
  11. Sutlief SG. Protection and measurement in radiation therapy. Health physics. 2015; 108: 224-41.
  12. Pawel DJ, Puskin JS. US environmental protection agency radiogenic risk models and projections for the US population. Health Physics. 2012; 10: 646-56.
  13. Movsas B, Hanlon AL, Pinover W, Hanks GE. Is there an increased risk of second primaries following prostate irradiation? International Journal of Radiation Oncology* Biology* Physics. 1998; 41: 251-5.
  14. Roychoudhuri R, Evans H, Robinson D, Møller H. Radiation-induced malignancies following radiotherapy for breast cancer. British journal of cancer. 2004; 91: 868.
  15. Brenner DJ, Sachs RK. Estimating radiation-induced cancer risks at very low doses: rationale for using a linear no-threshold approach. Radiation and environmental biophysics. 2006; 44: 253-6.
  16. Schaapveld M, Visser O, Louwman MJ, de Vries EG, Willemse PH, Otter R, et al. Risk of new primary nonbreast cancers after breast cancer treatment: a Dutch population-based study. Journal of Clinical Oncology. 2008; 26: 1239-46.
  17. Adams J, Shore RE, Dozier A, Lipshultz SE, Schwartz RG, Constine LS, et al. Thyroid cancer risk 40+ years after irradiation for an enlarged thymus: an update of the Hempelmann cohort. Radiation research. 2010; 174: 753-62.
  18. Kry S, Howell R. Second solid cancers after radiotherapy for breast cancer in SEER cancer registries: Berrington de Gonzalez A, Curtis RE, Gilbert E, et al (Natl Cancer Inst, Bethesda, MD; et al) Br J Cancer 102: 220-226, 2010 §. Breast Diseases: a YB Quarterly. 2010; 21: 271-2.
  19. Grantzau T, Mellemkjær L, Overgaard J. Second primary cancers after adjuvant radiotherapy in early breast cancer patients: a national population based study under the Danish Breast Cancer Cooperative Group (DBCG). Radiotherapy and Oncology. 2013; 106: 42-9.
  20. UNSCotEoA R. Effects of ionizing radiation: UNSCEAR 2006 Report to the General Assembly, with scientific annexes. Place United Nations Publications: United Nations Publications; 2009.
  21. Protection R. ICRP publication 103. Ann ICRP. 2007; 37: 2.
  22. Schauer DA, Linton OW. National Council on Radiation Protection and Measurements report shows substantial medical exposure increase. Place Radiological Society of North America, Inc.: Radiological Society of North America, Inc; 2009.
  23. Reiff JE. American Association of Physicists in Medicine (AAPM). Encyclopedia of Radiation Oncology. 2013: 9-9.
  24. Council NR. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2: National Academies Press; 2006.
  25. Donovan E, James H, Bonora M, Yarnold J, Evans P. Second cancer incidence risk estimates using BEIR VII models for standard and complex external beam radiotherapy for early breast cancer. Medical physics. 2012; 39: 5814-24.
  26. Bleyer A, Barr R. Cancer in young adults 20 to 39 years of age: overview. Seminars in oncology. Place Elsevier: Elsevier; 2009.
  27. Karimizarchi H, Chaparian A. Estimating risk of exposure induced cancer death in patients undergoing computed tomography pulmonary angiography. Radioprotection. 2017; 52, 81-6.
  28. Chaparian A, Zarchi HK. Assessment of radiation-induced cancer risk to patients undergoing computed tomography angiography scans. International Journal of Radiation Research. 2018; 16, 107-15.
  29. Tercilla O, Krasin F, Lawn-Tsao L. Comparison of contralateral breast doses from 1 2 beam block and isocentric treatment techniques for patients treated with primary breast irradiation with CO-60: International Journal of Radiation Oncology, Biology, Physics, vol. 17, no. 1, July 1989, pp. 205–210. Medical Dosimetry. 1990; 15: 33-4.
  30. Ueki N, Matsuo Y, Togashi Y, Kubo T, Shibuya K, Iizuka Y, et al. Impact of pretreatment interstitial lung disease on radiation pneumonitis and survival after stereotactic body radiation therapy for lung cancer. Journal of Thoracic Oncology. 2015; 10: 116-25.
  31. Abo-Madyan Y, Aziz MH, Aly MM, Schneider F, Sperk E, Clausen S, et al. Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer. Radiotherapy and Oncology. 2014; 110, 471-6.
  32. Grantzau T, Thomsen MS, Væth M, Overgaard J. Risk of second primary lung cancer in women after radiotherapy for breast cancer. Radiotherapy and Oncology, 2014; 111: 366-73.
  33. De Gonzalez AB, Curtis R, Gilbert E, Berg C, Smith S, Stovall M, et al. Second solid cancers after radiotherapy for breast cancer in SEER cancer registries. British journal of cancer. 2010; 102: 220.
  34. Baverstock K, Egloff B, Pinchera A, Ruchti C, Williams D. Thyroid cancer after Chernobyl. Nature. 1992; 359: 21.
  35. Shore RE, Hildreth N, Dvoretsky P, Andresen E, Moseson M, Pasternack B. Thyroid cancer among persons given X-ray treatment in infancy for an enlarged thymus gland. American journal of epidemiology. 1993; 137: 1068-80.
  36. Ron E, Lubin JH, Shore RE, Mabuchi K, Modan B, Pottern LM, et al. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiation research. 1995; 14: 259-77.
  37. De Vathaire F, Hardiman C, Shamsaldin A, Campbell S, Grimaud E, Hawkins M, et al. Thyroid carcinomas after irradiation for a first cancer during childhood. Archives of internal medicine. 1999; 159: 2713-9.
  38. Farahati J, Demidchik EP, Biko J, Reiners C. Inverse association between age at the time of radiation exposure and extent of disease in cases of radiationā€induced childhood thyroid carcinoma in Belarus. Cancer. 2000; 88: 1470-6.
  39. Momeni Z, Tavakoli MB, Atarod M. Estimation of the thyroid secondary cancer risk on the patient of standard breast external beam radiotherapy. Journal of medical signals and sensors. 2018; 8: 238.
  40. Boice Jr JD, Engholm G, Kleinerman RA, Blettner M, Stovall M, Lisco H, et al. Radiation dose and second cancer risk in patients treated for cancer of the cervix. Radiation research. 1988; 116: 3-55.
  41. Hallquist A, Hardell L, Löfroth P-O. External radiotherapy prior to thyroid cancer: a case-control study. International Journal of Radiation Oncology* Biology* Physics. 1993; 27: 1085-9.
  42. Mattsson A, Hall P, Rudén BI, Rutqvist LE. Incidence of primary malignancies other than breast cancer among women treated with radiation therapy for benign breast disease. Radiation research. 1997; 148: 152-60.
  43. Kourinou KM, 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. Physica Medica. 2013; 29: 650-5.
  44. Kim DW, Chung K, Chung WK, Bae SH, Shin DO, Hong S, et al. Risk of secondary cancers from scattered radiation during intensity-modulated radiotherapies for hepatocellular carcinoma. Radiation oncology. 2014; 9: 109.
  45. Lee B, Lee S, Sung J, Yoon M. Radiotherapy-induced secondary cancer risk for breast cancer: 3D conformal therapy versus IMRT versus VMAT. Journal of radiological protection. 2014; 34: 325.
  46. Hall EJ, Wuu C-S. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. International Journal of Radiation Oncology* Biology* Physics. 2003; 56: 83-8.

 

Volume 18, Issue 4
July and August 2021
Pages 278-284
  • Receive Date: 02 April 2020
  • Revise Date: 24 June 2020
  • Accept Date: 28 June 2020
  • First Publish Date: 01 July 2021