Background Breast cancer (BC) risk is increased among Hodgkin lymphoma (HL) survivors treated with chest radiotherapy. Case-control studies showed a linear radiation dose-response relationship for estimated dose to the breast tumor location. However, these relative risks cannot be used for absolute risk prediction of BC anywhere in the breasts. Furthermore, the independent and joint effects of radiation dose and irradiated volumes are unclear. Therefore, we examined the effects of mean breast dose and various dose-volume parameters on BC risk in HL patients. Methods We conducted a nested case-control study of BC among five-year HL survivors (173 cases, 464 matched controls). Dose-volume histograms (DVHs) were obtained from reconstructed voxel-based three-dimensional dose distributions. Summary parameters of DVH were studied next to mean and median breast dose, Gini index and the new dose metric mean absolute difference (MAD) of dose, using categorical and linear excess odds ratio (EOR) models. Interactions between dose-volume parameters and mean dose were also examined. Results Statistically significant linear dose-response relationships were observed for mean breast dose (EOR/Gy: 0.19; 95% confidence interval [CI]: 0.05 to 1.06) and median dose (EOR/Gy: 0.06; 95% CI: 0.02 to 0.19), with no statistically significant curvature. All metrics except Gini and MAD were positively correlated with each other. These metrics all showed similar patterns of dose-response that were no longer statistically significant when adjusting for mean dose. No statistically significant modification of the effect of mean dose was observed. Conclusion Mean breast dose predicts subsequent BC risk in long-term HL survivors.

中文翻译：

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放疗相关剂量和照射体积对霍奇金淋巴瘤幸存者乳腺癌风险的影响

背景 接受胸部放疗的霍奇金淋巴瘤 (HL) 幸存者患乳腺癌 (BC) 的风险增加。病例对照研究显示，乳腺肿瘤位置的估计剂量呈线性辐射剂量-反应关系。然而，这些相对风险不能用于乳房任何部位 BC 的绝对风险预测。此外，辐射剂量和辐射量的独立和联合影响尚不清楚。因此，我们检查了平均乳房剂量和各种剂量体积参数对 HL 患者 BC 风险的影响。方法 我们对 5 年 HL 幸存者（173 例，464 名匹配对照）进行了巢式病例对照研究。从重建的基于体素的三维剂量分布中获得剂量体积直方图 (DVH)。使用分类和线性超额优势比 (EOR) 模型，除了平均和中位乳房剂量、基尼指数和新的剂量度量平均绝对差 (MAD) 之外，研究了 DVH 的汇总参数。还检查了剂量-体积参数和平均剂量之间的相互作用。结果 观察到平均乳房剂量（EOR/Gy：0.19；95% 置信区间 [CI]：0.05 至 1.06）和中位剂量（EOR/Gy：0.06；95% CI：0.02 至 0.19）具有统计学意义的线性剂量反应关系)，没有统计上显着的曲率。除 Gini 和 MAD 外，所有指标均呈正相关。这些指标都显示出相似的剂量反应模式，在调整平均剂量时不再具有统计学意义。没有观察到平均剂量效应的统计学显着变化。