Radiation dose to heart and cardiac substructures and risk of coronary artery disease in early breast cancer patients: A DBCG study based on modern radiation therapy techniques.

Autor: Holm Milo ML; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Oncology, Aalborg University Hospital, Denmark. Electronic address: milo@oncology.au.dk., Slot Møller D; Department of Medical Physics, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark., Bisballe Nyeng T; Department of Medical Physics, Aarhus, Denmark., Hoffmann L; Department of Medical Physics, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark., Dahl Nissen H; Department of Medical Physics, Vejle Hospital, Denmark., Jensen I; Department of Medical Physics, Aalborg University Hospital, Denmark., Laugaard Lorenzen E; Laboratory of Radiation Physics, Odense University Hospital, Denmark., Bech Jellesmark Thorsen L; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Oncology, Aarhus University Hospital, Denmark., Melgaard Nielsen K; Department of Cardiology, Aarhus University Hospital, Denmark., Paaske Johnsen S; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University Hospital, Denmark., Brink Valentin J; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University Hospital, Denmark., Alsner J; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark., Vrou Offersen B; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2023 Mar; Vol. 180, pp. 109453. Date of Electronic Publication: 2023 Jan 13.
DOI: 10.1016/j.radonc.2022.109453
Abstrakt: Background: Coronary artery disease (CAD) has been reported as a late effect following radiation therapy (RT) of early breast cancer (BC). This study aims to report individual RT doses to the heart and cardiac substructures in patients treated with CT-based RT and to investigate if a dose-response relationship between RT dose and CAD exists using modern radiation therapy techniques.
Methods: Patients registered in the Danish Breast Cancer Group database from 2005 to 2016 with CT-based RT were eligible. Among 15,765 patients, the study included 204 with CAD after irradiation (cases) and 408 matched controls. Individual planning CTs were retrieved, the heart and cardiac substructures were delineated and dose-volume parameters were extracted.
Results: The median follow-up time was 7.3 years (IQR: 4.6-10.0). Among cases, the median mean heart dose was 1.6 Gy (IQR 0.2-6.1) and 0.8 Gy (0.1-2.9) for left-sided and right-sided patients, respectively (p < 0.001). The highest RT doses were observed in the left ventricle and left anterior descending coronary artery for left-sided RT and in the right atrium and the right coronary artery after right-sided RT. The highest left-minus-right dose-difference was located in the distal part of the left anterior descending coronary artery where also the highest left-versus-right ratio of events was observed. However, no significant difference in the distribution of CAD was observed by laterality. Furthermore, no significant differences in the dose-volume parameters were observed for cases versus controls.
Conclusions: CAD tended to occur in the part of the heart with the highest left-minus- right dose difference, however, no significant risk of CAD was observed at 7 years' median follow-up.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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