J Breast Cancer.  2018 Jun;21(2):206-212. 10.4048/jbc.2018.21.2.206.

Which Patients with Left Breast Cancer Should be Candidates for Heart-Sparing Radiotherapy?

• Cho WK
• Park W
• Choi DH
• Cha H
• Nam SJ
• Kim SW
• Lee JE
• Yu J
• Im YH
• Ahn JS
• Park YH
• Kim JY

• KMID: 2413940
• DOI: http://doi.org/10.4048/jbc.2018.21.2.206

Abstract

PURPOSE
This study aimed to identify risk factors that have significant interaction with radiation exposure to the heart, and thus to determine candidates for heart-sparing radiotherapy (RT) among women with left breast cancer.
METHODS
We identified 4,333 patients who received adjuvant RT following breast-conserving surgery for ductal carcinoma in situ or invasive breast cancer from 1996 to 2010. Incidence rates of cardiovascular disease were compared between left-sided and right-sided RT, and stratified by age and risk factors such as body mass index (BMI), smoking, hyperlipidemia, hypertension, diabetes, administration of anthracycline, and trastuzumab.
RESULTS
In all patients, the cumulative incidence of cardiovascular disease was greater in patients treated with left-sided RT than in those treated with right-sided RT, but the difference was not significant (p=0.428). Smoking (hazard ratio [HR], 5.991; 95% confidence interval [CI], 2.109-17.022; p=0.002) and hyperlipidemia (HR, 5.567; 95% CI, 3.235-9.580; p<0.001) were the most powerful risk factors for cardiovascular disease. There was no significant factor that further increased the risk of cardiovascular disease after left breast RT compared to right breast RT.
CONCLUSION
Although hyperlipidemia and smoking are risk factors for cardiovascular disease, they have not been proven to increase the risk of RT-related cardiovascular disease in Korean women.

Keyword

Breast neoplasms; Cardiotoxicity; Radiotherapy

MeSH Terms

Body Mass Index
Breast Neoplasms*
Breast*
Carcinoma, Intraductal, Noninfiltrating
Cardiotoxicity
Cardiovascular Diseases
Female
Heart
Humans
Hyperlipidemias
Hypertension
Incidence
Mastectomy, Segmental
Radiation Exposure
Radiotherapy*
Risk Factors
Smoke
Smoking
Trastuzumab
Smoke
Trastuzumab

Figure

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  Figure 1 Patient selection process.RT=radiotherapy.

• 

  Figure 2 Cumulative incidence of cardiovascular disease in patients who received radiotherapy for breast cancer according to laterality. Incidence of cardiovascular disease in all patients according to tumor laterality (A), hyperlipidemia and tumor laterality (B), smoking and tumor laterality (C).Lt=left; Rt=right; HyL=hyperlipidemia.

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