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Risk of Cardiac Disease in Patients With Breast Cancer: Impact of Patient-Specific Factors and Individual Heart Dose From Three-Dimensional Radiation Therapy Planning

Authors
 Seung Yeun Chung  ;  Jaewon Oh  ;  Jee Suk Chang  ;  Jaeyong Shin  ;  Kyung Hwan Kim  ;  Kyeong-Hyeon Chun  ;  Ki Chang Keum  ;  Chang-Ok Suh  ;  Seok-Min Kang  ;  Yong Bae Kim 
Citation
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, Vol.110(2) : 473-481, 2021-06 
Journal Title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
ISSN
 0360-3016 
Issue Date
2021-06
MeSH
Adult ; Aged ; Aged, 80 and over ; Anthracyclines / therapeutic use ; Asian Continental Ancestry Group ; Breast Neoplasms / drug therapy ; Breast Neoplasms / radiotherapy* ; Breast Neoplasms / surgery ; Cardiotoxicity / etiology ; Diabetes Mellitus ; Dose Fractionation, Radiation ; Dose-Response Relationship, Radiation ; Exercise ; Female ; Heart / radiation effects* ; Heart Diseases / etiology* ; Humans ; Hypertension / complications ; Kaplan-Meier Estimate ; Mastectomy / methods ; Middle Aged ; Proportional Hazards Models ; Radiation Dosage ; Radiotherapy Planning, Computer-Assisted* ; Radiotherapy, Adjuvant / adverse effects ; Retrospective Studies ; Risk ; Risk Factors ; Young Adult
Abstract
Purpose: This retrospective cohort study aimed to determine whether adjuvant radiation therapy increases the risk of cardiac toxicity in Asian women with breast cancer, with a focus on patient-specific factors.

Methods and materials: We evaluated women who underwent primary breast surgery for breast cancer with (n = 520) or without (n = 774) adjuvant radiation therapy between January 2005 and May 2013. Patients who underwent breast surgery without radiation therapy were categorized as patients who received 0 Gy to the heart. The primary endpoint was the occurrence of a breast cancer treatment-related heart disease (BCT-HD), defined as a diagnosis of angina pectoris, unstable angina, myocardial infarction, ischemic heart disease, heart failure, or atrial fibrillation.

Results: In total, 1294 patients were included. The overall 5- and 10-year BCT-HD rates were 2.4% and 5.7%, respectively. The risk of an BCT-HD significantly increased per 1-Gy increase in the mean heart dose (adjusted hazard ratio: 1.23). Additionally, histories of hypertension (hazard ratio: 1.92), and diabetes (hazard ratio: 2.51) were found to be adverse risk factors, whereas regular physical exercise (hazard ratio: 0.17) was a protective factor. Subgroup analysis according to risk groups showed that the effect of increasing mean heart dose (per Gy) was similar between women without or with minimal risk factors (hazard ratio: 1.23) and women with multiple risk factors (hazard ratio: 1.27).

Conclusions: The results indicate a radiation dose-effect relationship for cardiac disease in breast cancer patients, highlighting that there remains a considerable risk of cardiac toxicity even with 3-dimensional radiation therapy planning. Thus, measures to minimize the heart dose in breast cancer patients undergoing adjuvant radiation therapy, even in those without any risk factor for cardiac disease, should be routinely implemented.
Full Text
https://www.redjournal.org/article/S0360-3016(21)00003-1/fulltext
DOI
10.1016/j.ijrobp.2020.12.053
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Kyung Hwan(김경환)
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Suh, Chang Ok(서창옥)
Shin, Jae Yong(신재용)
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Chun, Kyeong Hyeon(전경현) ORCID logo https://orcid.org/0000-0002-7798-658X
Chung, Seung Yeun(정승연) ORCID logo https://orcid.org/0000-0002-3877-6950
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186879
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