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Toxicity of internal mammary irradiation in breast cancer. Are concerns still justified in times of modern treatment techniques?
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SYSNO ASEP 0531056 Document Type J - Journal Article R&D Document Type Journal Article Subsidiary J Článek ve WOS Title Toxicity of internal mammary irradiation in breast cancer. Are concerns still justified in times of modern treatment techniques? Author(s) Borm, K. J. (DE)
Simonetto, C. (DE)
Kundrát, Pavel (UJF-V) RID, ORCID, SAI
Eidemuller, M. (DE)
Oechsner, M. (DE)
Dusberg, M. (DE)
Combs, S. E. (DE)Number of authors 7 Source Title Acta Oncologica - ISSN 0284-186X
Roč. 59, č. 10 (2020), s. 1201-1209Number of pages 9 s. Publication form Print - P Language eng - English Country GB - United Kingdom Keywords internal mammary node irradiation ; regional lymph node irradiation ; overall survival Subject RIV FP - Other Medical Disciplines OECD category Radiology, nuclear medicine and medical imaging Method of publishing Limited access Institutional support UJF-V - RVO:61389005 UT WOS 000546296100001 EID SCOPUS 85087635143 DOI 10.1080/0284186X.2020.1787509 Annotation Background:The purpose of this study was to estimate the additional risk of side effects attributed to internal mammary node irradiation (IMNI) as part of regional lymph node irradiation (RNI) in breast cancer patients and to compare it with estimated overall survival (OS) benefit from IMNI. Material and methods:Treatment plans (n = 80) with volumetric modulated arc therapy (VMAT) were calculated for 20 patients (4 plans per patient) with left-sided breast cancer from the prospective GATTUM trial in free breathing (FB) and in deep inspiration breath hold (DIBH). We assessed doses to organs at risk ((OARs) lung, contralateral breast and heart) during RNI with and without additional IMNI. Based on the OAR doses, the additional absolute risks of 10-year cardiac mortality, pneumonitis, and secondary lung and breast cancer were estimated using normal tissue complication probability (NTCP) and risk models assuming different age and risk levels. Results:IMNI notably increased the mean OAR doses. The mean heart dose increased upon IMNI by 0.2-3.4 Gy (median: 1.9 Gy) in FB and 0.0-1.5 Gy (median 0.4 Gy) in DIBH. However, the estimated absolute additional 10-year cardiac mortality caused by IMNI was <0.5% for all patients studied except 70-year-old high risk patients (0.2-2.4% in FB and 0.0-1.1% in DIBH). In comparison to this, the published oncological benefit of IMNI ranges between 3.3% and 4.7%. The estimated additional 10-year risk of secondary cancer of the lung or contralateral breast ranged from 0-1.5% and 0-2.8%, respectively, depending on age and risk levels. IMNI increased the pneumonitis risk in all groups (0-2.2%). Conclusion:According to our analyses, the published oncological benefit of IMNI outweighs the estimated risk of cardiac mortality even in case of (e.g., cardiac) risk factors during VMAT. The estimated risk of secondary cancer or pneumonitis attributed to IMNI is low. DIBH reduces the estimated additional risk of IMNI even further and should be strongly considered especially in patients with a high baseline risk. Workplace Nuclear Physics Institute Contact Markéta Sommerová, sommerova@ujf.cas.cz, Tel.: 266 173 228 Year of Publishing 2021 Electronic address https://doi.org/10.1080/0284186X.2020.1787509
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