A Literature Review of Late Complications of Radiation Therapy for Head and Neck Cancers: Incidence and Dose Response

Introduction: Lymphatic mapping and sentinel node biopsy (LM/ SNB) techniques for melanoma and breast cancer management potentially expose staff, including operating theatre personnel, radiologists, pathologists and others, to ionising radiation. Aims: To ascertain exposure levels in a practical setting and to establish safe work practices for staff involved in the LM/ SNB procedure pathway. Methods: Cumulative intra-procedural extremity (hands) and whole body radiation doses were recorded separately for surgeons, pathologists and couriers during standard sentinel lymph node biopsy procedures from 13 melanoma and included also radiologists in 11 breast cancer cases. Results: The measured extremity dose for melanoma procedures was zero for surgeons and pathologists. The extremity dose for breast cancer procedures was approximately 250 μSv for surgeons, and about 10 μSv for pathologists per breast procedure if done on the day of surgery, but is otherwise negligible; zero for the radiologist; and zero for the courier. No whole body dose was detectable for any staff member. Conclusions: Using the international limit for skin dose some 200 breast cancer procedures could be performed per annum per surgeon (at the general public radiation limit) – and 2000 breast surgical procedures (at the radiation worker limit) based on extremity doses. Radiologists, pathologists and couriers received minimal or zero radiation doses from handling breast specimens. Melanoma procedures showed no measurable dose. Some recommendations for effective safe work practices are given.