Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomised trials
<h4>Purpose</h4> <p>Radiotherapy reduces the absolute risk of breast cancer mortality by a few percent in suitable women, but can cause second cancer or heart disease decades later. We estimated the absolute long-term risks of modern breast cancer radiotherapy.</p> <h4>...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
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American Society of Clinical Oncology
2017
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| _version_ | 1797084782795948032 |
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| author | Taylor, C Correa, C Duane, F Aznar, M Anderson, S Bergh, J Dodwell, D Ewertz, M Gray, R Jagsi, R Pierce, L Pritchard, K Swain, S Wang, Z Wang, Y Whelan, T Peto, R McGale, P |
| author_facet | Taylor, C Correa, C Duane, F Aznar, M Anderson, S Bergh, J Dodwell, D Ewertz, M Gray, R Jagsi, R Pierce, L Pritchard, K Swain, S Wang, Z Wang, Y Whelan, T Peto, R McGale, P |
| author_sort | Taylor, C |
| collection | OXFORD |
| description | <h4>Purpose</h4> <p>Radiotherapy reduces the absolute risk of breast cancer mortality by a few percent in suitable women, but can cause second cancer or heart disease decades later. We estimated the absolute long-term risks of modern breast cancer radiotherapy.</p> <h4>Methods</h4> <p>First, a systematic literature review was performed of lung and heart doses in breast cancer regimens published during 2010-15.</p> <br/> <p>Second, individual patient data meta-analyses of 40,781 women randomised in 75 trials of breast cancer radiotherapy yielded rate ratios (RRs) for second primary cancers and cause-specific mortality, and excess RRs (ERRs) per Gy for incident lung cancer and cardiac mortality. Smoking status was unavailable.</p> <br/> <p>Third, the lung or heart ERRs/Gy in the trials and the 2010-15 doses were combined and applied to current smoker and non-smoker lung cancer and cardiac mortality rates in population-based data.</p> <h4>Results</h4> <p>Average doses from 647 regimens published 2010-15 were 5.7 Gy whole-lung and 4.4 Gy whole-heart. Median year of irradiation was 2010 (IQR 2008-2011).</p> <br/> <p>Meta-analyses yielded lung cancer incidence 10+ years after radiotherapy RR=2.10 (95%CI 1.48-2.98, p<0.0001) based on 134 cancers, indicating 0.11 (0.05-0.20) ERR/Gy whole-lung dose. For cardiac mortality RR=1.30 (1.15-1.46, p<0.0001) based on 1253 cardiac deaths. Detailed analyses indicated 0.04 (0.02-0.06) ERR/Gy whole-heart dose.</p> <br/> <p>Estimated absolute risks from modern radiotherapy were: Lung cancer ~4% for long-term continuing smokers, but 0.3% for non-smokers; cardiac mortality ~1% for smokers and 0.3% for non-smokers.</p> <h4>Conclusions</h4> <p>For long-term smokers, the absolute risks of modern radiotherapy may outweigh the benefits yet for most non-smokers (and ex-smokers) the benefits of radiotherapy far outweigh the risks. Hence smoking can determine the net effect of radiotherapy on mortality; but smoking cessation substantially reduces radiotherapy-risk.</p> |
| first_indexed | 2024-03-07T01:59:52Z |
| format | Journal article |
| id | oxford-uuid:9cf9c89c-ff44-47da-93f4-22d8581f7c9b |
| institution | University of Oxford |
| last_indexed | 2024-03-07T01:59:52Z |
| publishDate | 2017 |
| publisher | American Society of Clinical Oncology |
| record_format | dspace |
| spelling | oxford-uuid:9cf9c89c-ff44-47da-93f4-22d8581f7c9b2022-03-27T00:39:54ZEstimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomised trialsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9cf9c89c-ff44-47da-93f4-22d8581f7c9bSymplectic Elements at OxfordAmerican Society of Clinical Oncology2017Taylor, CCorrea, CDuane, FAznar, MAnderson, SBergh, JDodwell, DEwertz, MGray, RJagsi, RPierce, LPritchard, KSwain, SWang, ZWang, YWhelan, TPeto, RMcGale, P <h4>Purpose</h4> <p>Radiotherapy reduces the absolute risk of breast cancer mortality by a few percent in suitable women, but can cause second cancer or heart disease decades later. We estimated the absolute long-term risks of modern breast cancer radiotherapy.</p> <h4>Methods</h4> <p>First, a systematic literature review was performed of lung and heart doses in breast cancer regimens published during 2010-15.</p> <br/> <p>Second, individual patient data meta-analyses of 40,781 women randomised in 75 trials of breast cancer radiotherapy yielded rate ratios (RRs) for second primary cancers and cause-specific mortality, and excess RRs (ERRs) per Gy for incident lung cancer and cardiac mortality. Smoking status was unavailable.</p> <br/> <p>Third, the lung or heart ERRs/Gy in the trials and the 2010-15 doses were combined and applied to current smoker and non-smoker lung cancer and cardiac mortality rates in population-based data.</p> <h4>Results</h4> <p>Average doses from 647 regimens published 2010-15 were 5.7 Gy whole-lung and 4.4 Gy whole-heart. Median year of irradiation was 2010 (IQR 2008-2011).</p> <br/> <p>Meta-analyses yielded lung cancer incidence 10+ years after radiotherapy RR=2.10 (95%CI 1.48-2.98, p<0.0001) based on 134 cancers, indicating 0.11 (0.05-0.20) ERR/Gy whole-lung dose. For cardiac mortality RR=1.30 (1.15-1.46, p<0.0001) based on 1253 cardiac deaths. Detailed analyses indicated 0.04 (0.02-0.06) ERR/Gy whole-heart dose.</p> <br/> <p>Estimated absolute risks from modern radiotherapy were: Lung cancer ~4% for long-term continuing smokers, but 0.3% for non-smokers; cardiac mortality ~1% for smokers and 0.3% for non-smokers.</p> <h4>Conclusions</h4> <p>For long-term smokers, the absolute risks of modern radiotherapy may outweigh the benefits yet for most non-smokers (and ex-smokers) the benefits of radiotherapy far outweigh the risks. Hence smoking can determine the net effect of radiotherapy on mortality; but smoking cessation substantially reduces radiotherapy-risk.</p> |
| spellingShingle | Taylor, C Correa, C Duane, F Aznar, M Anderson, S Bergh, J Dodwell, D Ewertz, M Gray, R Jagsi, R Pierce, L Pritchard, K Swain, S Wang, Z Wang, Y Whelan, T Peto, R McGale, P Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomised trials |
| title | Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomised trials |
| title_full | Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomised trials |
| title_fullStr | Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomised trials |
| title_full_unstemmed | Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomised trials |
| title_short | Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomised trials |
| title_sort | estimating the risks of breast cancer radiotherapy evidence from modern radiation doses to the lungs and heart and from previous randomised trials |
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