AI Article Synopsis
- The study aimed to explore how the dose-volume distribution to the oesophagus affects the long-term risk of developing oesophageal cancer in breast cancer survivors who underwent radiation therapy.
- Conducted on a large cohort of over 289,000 breast cancer survivors, the research found that the median dose to the oesophagus was a key indicator of cancer risk, particularly in the most common subtype, squamous cell carcinoma.
- The results suggest that higher volumes of the oesophagus exposed to high radiation doses increase cancer risk, indicating that improving current radiation techniques could further lower these risks.
Article Abstract
Purpose: To investigate the relationship between oesophagus dose-volume distribution and long-term risk of oesophageal cancer after radiation therapy for breast cancer.
Materials And Methods: In a case-control study nested within a cohort of 289,748 ≥5-year survivors of female breast cancer treated in 1943-2003 in five countries, doses to the second primary cancer (D) and individual dose-volume histograms (DVH) to the entire oesophagus were reconstructed for 252 oesophageal cancer cases and 488 matched controls (median follow-up time: 13, range: 5-37 years). Using conditional logistic regression, we estimated excess odds ratios (EOR) of oesophageal cancer associated with DVH metrics. We also investigated whether DVH metrics confounded or modified D-related -risk estimates.
Results: Among the DVH metrics evaluated, median dose (D) to the entire oesophagus had the best statistical performance for estimating risk of all histological types combined (EOR/Gy = 0.071, 95% confidence interval [CI]: 0.018 to 0.206). For squamous cell carcinoma, the most common subtype, the EOR/Gy for D increased by 31% (95% CI: 3% to 205%) for each increment of 10% of V30 (p = 0.02). Adjusting for DVH metrics did not materially change the EOR/Gy for D, but there was a borderline significant positive interaction between D and V30 (p = 0.07).
Conclusion: This first study investigating the relationship between oesophagus dose-volume distribution and oesophageal cancer risk showed an increased risk per Gy for D with larger volumes irradiated at high doses. While current techniques allows better oesophagus sparing, constraints applied to D and V30 could potentially further reduce the risk of oesophageal cancer.
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| http://dx.doi.org/10.1016/j.radonc.2020.07.022 | DOI Listing |
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