Radiation dose and contralateral breast cancer risk associated with megavoltage cone-beam computed tomographic image verification in breast radiation therapy |
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| Authors: | Alexandra Quinn Lois Holloway Eng-Siew Koh Geoff Delaney Sankar Arumugam Gary Goozee Peter Metcalfe |
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| Institution: | 1. Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia;2. Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia;3. School of Physics, University of Sydney, Sydney, NSW, Australia;4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia;5. Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Liverpool, NSW, Australia;6. School of Medicine, University of Western Sydney, Sydney, NSW, Australia;1. American Society for Radiation Oncology, Fairfax, Virginia;2. Dana-Farber Cancer Institute, Boston, Massachusetts;3. North Shore-Long Island Jewish Health System, New Hyde Park, New York;1. Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA;2. Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA;3. Department of Environmental Medicine, New York University, New York, NY, USA;4. Radiation Effects Research Foundation, Hiroshima, Japan;5. Department of Clinical Genetics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA;6. Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA;7. National Council on Radiation Protection and Measurements, Bethesda, MD, USA;8. Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA;9. Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark;10. Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, USA;11. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA;12. Department of Epidemiology, University of Iowa, Iowa City, IA, USA;13. Department of Oncology, Clinical Sciences, Lund University, Sweden;14. Department of Biochemistry and Molecular Genetics and Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA;15. Danish Cancer Society Research Center, Copenhagen, Denmark |
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| Abstract: | PurposeTo measure and compare organ doses from a standard tangential breast radiation therapy treatment (50 Gy delivered in 25 fractions) and a megavoltage cone-beam computed tomography (MV-CBCT), taken for weekly image verification, and assess the risk of radiation-induced contralateral breast cancer.Methods and MaterialsOrgan doses were measured with thermoluminescent dosimeters placed strategically within a female anthropomorphic phantom. The risk of radiation-induced secondary cancer of the contralateral breast was estimated from these values using excess absolute risk and excess relative risk models.ResultsThe effective dose from a MV-CBCT (8-monitor units) was 35.9 ± 0.2 mSv. Weekly MV-CBCT imaging verification contributes 0.5% and 17% to the total ipsilateral and contralateral breast dose, respectively. For a woman irradiated at age 50 years, the 10-year postirradiation excess relative risk was estimated to be 0.8 and 0.9 for treatment alone and treatment plus weekly MV-CBCT imaging, respectively. The 10-year postirradiation excess absolute risk was estimated to be 4.7 and 5.6 per 10,000 women-years.ConclusionsThe increased dose and consequent radiation-induced second cancer risk as calculated by this study introduced by the imaging verification protocols utilizing MV-CBCT in breast radiation therapy must be weighed against the benefits of more accurate treatment. As additional image verification becomes more common, it is important that data be collected in regard to long-term malignancy risk. |
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