Radiation exposure of breast tissue in lymphoma radiotherapy: a systematic review of breast dose metrics published since 2000

Authors

  • Hannah Chamberlin Radiotherapy Related Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK https://orcid.org/0000-0003-0541-220X
  • Georgios Ntentas Guy's and St Thomas' NHS Foundation Trust, Medical Physics, London, United Kingdom; University of Oxford, Nuffield Department of Population Health, London, United Kingdom; King's College London, School of Biomedical Engineering & Imaging Sciences, London, United Kingdom
  • David J. Cutter University of Oxford, Nuffield Department of Population Health, London, United Kingdom; Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  • Richard Cowan Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
  • Sacha Howell Division of Cancer Sciences, University of Manchester, Manchester, UK
  • Christina Hague Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
  • John Radford Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
  • Sue Astley Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  • Eliana Vasquez Osorio Radiotherapy Related Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK
  • Marianne Aznar Radiotherapy Related Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK

DOI:

https://doi.org/10.2340/1651-226X.2025.43177

Keywords:

lymphoma, radiotherapy, radiation dosage, systematic review, breast, cancers, radiation induced

Abstract

Background and purpose: We present a systematic review of breast dose metrics reported in lymphoma patients receiving radiotherapy and provide reporting recommendations for breast dose in future publications.

Methods and materials: Studies reporting breast doses in lymphoma radiotherapy published between January 2000 and May 2023 were included. Frequency of reporting factors likely to affect breast dose were calculated. Doses for the most frequently reported metrics (mean breast dose (MBD) (Gy, percentage of prescription), V5Gy and V10Gy (%)) were calculated across articles and compared for target volume approaches, radiotherapy techniques, and inclusion of the axilla.

Results: Thirty-four distinct breast dose metrics were found across 57 articles. MBD was the most commonly reported. Axilla irradiation significantly increased MBD, V5Gy and V10Gy, yet 21 articles reported breast doses for a mixed cohort with respect to axillary irradiation. Forty-eight of 57 articles did not report the breast contouring guidelines used. Among articles reporting MBD for proton or butterfly-volumetric modulated arc therapy (VMAT), there was no significant reduction in breast radiation dose for protons compared to butterfly-VMAT.

Interpretation: A wide variety of breast dose metrics are reported in the literature, making it challenging to pool breast tissue exposure data in lymphoma radiotherapy. Factors shown in individual studies to affect breast dose should be reported more systematically to enable large scale analysis. Reporting the presence/absence of axillary irradiation is crucial, due to the significant effect on breast dose. We provide reporting recommendations for breast dose metrics to improve research into radiotherapy-induced breast cancer.

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Published

2025-08-26

How to Cite

Chamberlin, H., Ntentas, G., Cutter, D. J., Cowan, R., Howell, S., Hague, C., … Aznar, M. (2025). Radiation exposure of breast tissue in lymphoma radiotherapy: a systematic review of breast dose metrics published since 2000. Acta Oncologica, 64, 1117–1124. https://doi.org/10.2340/1651-226X.2025.43177

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Vol. 64 (2025): Acta Oncologica

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Original article

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Copyright (c) 2025 Hannah Chamberlin, Georgios Ntentas, David J. Cutter, Richard Cowan, Sacha Howell, Christina Hague, John Radford, Sue Astley, Eliana Vasquez Osorio, Marianne Aznar

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