International journal of radiation oncology, biology, physics · 2026
The Impact of Breast Radiation Technique on Secondary Lung Cancer Risk Modeling: An Analysis based on Clinically Delivered Lung Doses of Various Modern Radiation Techniques and Target Volumes.
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Hoekstra Nienke, Kim Dong Ha, Vicini Frank A, Park Sejung, Jeong Jae-Uk, Chang Jee Suk
Аннотация
PURPOSE: The purpose of this paper is to estimate the projected lifetime risk of secondary lung cancer associated with breast radiation therapy-based on actual clinically delivered lung doses for various modern radiation techniques and target volumes.
METHODS AND MATERIALS: Four cohorts consisting of Korean patients with early-stage breast cancer were analyzed, treated with either stereotactic partial breast irradiation (PBI), 3-dimensional-conformal PBI, volumetric modulated arc therapy whole breast irradiation (WBI), or 3-dimensional-conformal WBI. Using the clinically delivered mean lung dose from computed tomography-based dose planning, converted to biologically effective dose (EQD2, α/β = 3 Gy), we modeled the excess lifetime risk (ELR) and relative risk (RR) of secondary lung cancer using the RadRAT online calculator. Individual-level model uncertainty was propagated via bootstrap resampling. Age at exposure and treatment year were fixed at 50 years and 2026 (primary analysis); an as-treated analysis served as secondary.
RESULTS: A total of 1690 patients were included, among whom 3.8% (n = 64) were current or former smokers. The bootstrap-based median ELR of secondary lung cancer was 2003, 1931, 2843, and 3738 cases per 100,000 patients in the stereotactic PBI, 3D-conformal PBI, volumetric modulated arc therapy WBI, and 3D-conformal WBI cohorts, respectively. Both PBI groups had significantly lower ELR and RR than the 2 WBI groups (Bonferroni-corrected P < .05), whereas the 2 PBI groups did not differ significantly from each other; these findings remained consistent in the secondary as-treated analysis. The RR ranged from 1.54 to 2.05, increasing the total lifetime risk from a baseline of 3.6% to 5.5-5.6% in the PBI groups and 6.4-7.3% in the WBI groups.
CONCLUSIONS: Model-based projections suggest that adjuvant radiation therapy in patients with early-stage breast cancer is associated with a dose-dependent increase in the risk of developing lung cancer during the remaining lifetime in Korean patients. A lower risk for secondary lung cancer is one of many factors to consider when deciding between PBI and WBI in low-risk breast cancer.
METHODS AND MATERIALS: Four cohorts consisting of Korean patients with early-stage breast cancer were analyzed, treated with either stereotactic partial breast irradiation (PBI), 3-dimensional-conformal PBI, volumetric modulated arc therapy whole breast irradiation (WBI), or 3-dimensional-conformal WBI. Using the clinically delivered mean lung dose from computed tomography-based dose planning, converted to biologically effective dose (EQD2, α/β = 3 Gy), we modeled the excess lifetime risk (ELR) and relative risk (RR) of secondary lung cancer using the RadRAT online calculator. Individual-level model uncertainty was propagated via bootstrap resampling. Age at exposure and treatment year were fixed at 50 years and 2026 (primary analysis); an as-treated analysis served as secondary.
RESULTS: A total of 1690 patients were included, among whom 3.8% (n = 64) were current or former smokers. The bootstrap-based median ELR of secondary lung cancer was 2003, 1931, 2843, and 3738 cases per 100,000 patients in the stereotactic PBI, 3D-conformal PBI, volumetric modulated arc therapy WBI, and 3D-conformal WBI cohorts, respectively. Both PBI groups had significantly lower ELR and RR than the 2 WBI groups (Bonferroni-corrected P < .05), whereas the 2 PBI groups did not differ significantly from each other; these findings remained consistent in the secondary as-treated analysis. The RR ranged from 1.54 to 2.05, increasing the total lifetime risk from a baseline of 3.6% to 5.5-5.6% in the PBI groups and 6.4-7.3% in the WBI groups.
CONCLUSIONS: Model-based projections suggest that adjuvant radiation therapy in patients with early-stage breast cancer is associated with a dose-dependent increase in the risk of developing lung cancer during the remaining lifetime in Korean patients. A lower risk for secondary lung cancer is one of many factors to consider when deciding between PBI and WBI in low-risk breast cancer.