Abstract
Background and purposeBreast cancer radiotherapy can increase the risk of subsequent primary oesophageal cancer, with risk increasing according to oesophagus radiation dose. We describe oesophagus exposure from modern breast cancer regimens and discuss the risks of oesophageal cancer for women irradiated recently. Materials and methodsA systematic review was undertaken of oesophagus doses from breast cancer radiotherapy regimens published during 2010–2020. Mean and maximum oesophagus doses were described for different target regions irradiated and different radiotherapy techniques. ResultsIn 112 published regimens from 18 countries, oesophagus doses varied with target region. For partial breast irradiation, average mean oesophagus dose was 0.2 Gy (range 0.1–0.4) in four regimens; maximum dose was not reported. For breast or chest wall radiotherapy, average oesophagus doses were mean 1.8 Gy (range 0.1–10.4) in 24 regimens and maximum 6.7 Gy (range 0.4–14.3) in seven regimens. For radiotherapy including a nodal region, average oesophagus doses were higher: mean 11.4 Gy (range <0.1–29.3) in 61 regimens and maximum 34.4 Gy (range 3.4–51.3) in 55 regimens. Average mean oesophagus doses were >10 Gy for intensity modulated nodal radiotherapy, but lower for other node techniques. ConclusionsMean oesophagus doses from partial breast and breast/chest wall regimens were usually less than 2 Gy, hence radiation-risks will be very small. However, for radiotherapy including lymph nodes, average mean oesophagus dose of 11.4 Gy may nearly double oesophageal cancer risk. Consideration of oesophageal exposure during nodal radiotherapy planning may reduce the risks of radiation-related oesophageal cancer for women irradiated today.
Highlights
Background and purposeBreast cancer radiotherapy can increase the risk of subsequent primary oesophageal cancer, with risk increasing according to oesophagus radiation dose
We present a systematic review of oesophagus doses from early breast cancer radiotherapy dosimetry studies published worldwide during 2010 to 2020
It was not possible to calculate equivalent dose in 2 Gy per fraction (EQD2) accurately as dose volume histograms for the oesophagus from the individual radiotherapy plans were not provided in the published studies
Summary
Background and purposeBreast cancer radiotherapy can increase the risk of subsequent primary oesophageal cancer, with risk increasing according to oesophagus radiation dose. We describe oesophagus exposure from modern breast cancer regimens and discuss the risks of oesophageal cancer for women irradiated recently. Materials and methods: A systematic review was undertaken of oesophagus doses from breast cancer radiotherapy regimens published during 2010–2020. Mean and maximum oesophagus doses were described for different target regions irradiated and different radiotherapy techniques. For breast or chest wall radiotherapy, average oesophagus doses were mean 1.8 Gy (range 0.1–10.4) in 24 regimens and maximum 6.7 Gy (range 0.4–14.3) in seven regimens. For radiotherapy including a nodal region, average oesophagus doses were higher: mean 11.4 Gy (range
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