Markerless pancreatic tumor target localization enabled by deep learning

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Publication date: Available online 13 June 2019

Source: International Journal of Radiation Oncology*Biology*Physics

Author(s): Wei Zhao, Liyue Shen, Bin Han, Yong Yang, Kai Cheng, Diego AS. Toesca, Albert C. Koong, Daniel T. Chang, Lei Xing

Abstract

Purpose

To estimate the impact of radiotherapy (RT) on non-breast second malignant neoplasms (SMNs) in young women survivors of stage I-IIIA breast cancer.

Methods and Materials

Women aged 20-44 years diagnosed with stage I-IIIA breast cancer (1988-2008) were identified in Surveillance, Epidemiology, and End Results (SEER) 9 registries. Bootstrapping approach and competing risk proportional hazards models were used to evaluate the effect of RT on non-breast SMN risk. The analysis was repeated in racial subgroups. Radio-tolerance score (RTS) analysis of normal airway epithelium was performed using Gene Expression Omnibus (GEO) datasets.

Results

Within records of 30,003 women with primary breast cancer, 20,516 eligible patients were identified (including 2,183 African Americans [AAs] and 16,009 Caucasians). The 25-year cumulative incidences of SMN were 5.2% and 3.6% (RT vs. no-RT) for AAs with 12.8-year and 17.4-year (RT vs. no-RT) median follow-up (HR=1.81, 95% bootstrapping confidence intervals [BCIs] [1.02, 2.50], P < 0.05); and 6.4% and 5.9% (RT vs. no-RT) for Caucasians with 14.3-year and 18.1-year (RT vs. no-RT) median follow-up (HR=1.10, 95% BCI [0.61, 1.40], P > 0.05). The largest portion of excess RT-related SMN risk was lung cancer (AA: HR=2.08, 95% BCI [1.02, 5.39], P < 0.05; Caucasian: HR=1.50, 95% BCI [0.84, 5.38], P > 0.05). STEPP analysis revealed higher post-RT non-breast SMN risk essentially throughout entire age range 20-44 years, with larger HR for RT in AAs. RTS of normal airway epithelium from young AA women was significantly lower than that from young Caucasian women (P = 0.038).

Conclusions

With a projected 25-year follow-up, RT is associated with elevated risk of non-breast SMNs, particularly second lung cancer, in young women survivors of stage I-IIIA breast cancer, especially higher in AA women than Caucasian women.