Mammary Chain Irradiation in Left-Sided Breast Cancer: Can We Reduce the Risk of Secondary Cancer and Ischaemic Heart Disease with Modern Intensity-Modulated Radiotherapy Techniques?

Overview

Journal Breast Care (Basel)

Publisher Karger

Date 2021 Oct 4

PMID 34602941

Citations 4

Authors

Vanessa Figlia

Cristoforo Simonetto

Markus Eidemuller

Stefania Naccarato

Gianluisa Sicignano

Antonio De Simone

Ruggero Ruggieri

Rosario Mazzola

Christiane Matuschek

Edwin Bolke

Montserrat Pazos

Maximilian Niyazi

Claus Belka

Filippo Alongi

Stefanie Corradini

Affiliations

Soon will be listed here.

Abstract

Introduction: The aim of the present study was to estimate the impact of the addition of internal mammary chain (IMC) irradiation in node-positive left-sided breast cancer (BC) patients undergoing regional nodal irradiation (RNI) and comparatively evaluate excess relative and absolute risks of radiation-induced lung cancer/BC and ischaemic heart disease for intensity-modulated radiotherapy (IMRT) versus 3D conformal radiotherapy (3D-CRT).

Methods: Four treatment plans were created (3D-CRT and IMRT -/+ IMC) for each of the 10 evaluated patients, and estimates of excess relative risk (ERR) and 10-year excess absolute risk (EAR) were calculated for radiation-induced lung cancer/BC and coronary events using linear, linear-exponential and plateau models.

Results: The addition of IMC irradiation to RNI signiﬁcantly increased the dose exposure of the heart, lung and contralateral breast using both techniques, increasing ERR for secondary lung cancer (58 vs. 44%, = 0.002), contralateral BC (49 vs. 31%, = 0.002) and ischaemic heart disease (41 vs. 27%, = 0.002, IMRT plans). IMRT signiﬁcantly reduced the mean cardiac dose and mean lung dose as compared to 3D-CRT, decreasing ERR for major coronary events (64% 3D-CRT vs. 41% IMRT, = 0.002) and ERR for secondary lung cancer (75 vs. 58%, = 0.004) in IMC irradiation, without a significant impact on secondary contralateral BC risks.

Conclusion: Although IMC irradiation has been shown to increase survival rates in node-positive BC patients, it increased dose exposure of organs at risk in left-sided BC, resulting in significantly increased risks for secondary lung cancer/contralateral BC and ischaemic heart disease. In this setting, the adoption of IMRT seems advantageous when compared to 3D-CRT.

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