The effect of coronary artery calcifications and radiotherapy on the risk of coronary artery disease in high-risk breast cancer patients in the DBCG RT-Nation cohort.

Autor: Refsgaard L; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: lasref@rm.dk., Holm Milo ML; Department of Oncology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark., Buhl ES; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark., Jensen JM; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Maae E; Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Denmark., Berg M; Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Denmark., Jensen I; Department of Oncology, Aalborg University Hospital, Aalborg, Denmark., Nielsen MH; Department of Oncology, Odense University Hospital, Odense, Denmark., Lorenzen EL; Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark., Jellesmark Thorsen LB; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Korreman SS; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark., Offersen BV; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2024 Dec 24, pp. 110705. Date of Electronic Publication: 2024 Dec 24.
DOI: 10.1016/j.radonc.2024.110705
Abstrakt: Background and Purpose: Radiotherapy improves outcomes for breast cancer. However, prior studies have correlated the risk of coronary artery disease (CAD) to the mean heart dose (MHD), mean dose to the left anterior descending artery (LAD_mean) and the left ventricle V5Gy (LV5). Other studies showed an increased risk of CAD for patients with pronounced coronary artery calcification (CAC) at the time of radiotherapy.
Materials and Methods: This cohort study included 3355 high-risk breast cancer patients treated in Western Denmark (2008-2016). We analysed CT scans, treatment plans, and dose distributions. CAC was measured using the Agatston score (AS). We examined the dose-response relationship between MHD, LV5 and LAD_mean and CAD, and the effect of CAC presence at radiotherapy. Secondary analysis assessed overall survival.
Results: Of 3355 patients, 45 (1.2 %) developed CAD during follow-up. AS was a strong predictor of CAD risk with a hazard ratio of 9.51(CI95:5.16-17.53) for AS ≥ 100 versus AS < 100 and a 6.7 % difference in absolute cumulative CAD risk at ten years (7.7 % vs 1 %). For AS < 100 (97 % of patients) CAD risk increased with MHD, hazard ratio 1.25 (CI95:1.01-1.56) per Gy. ForAS ≥ 100, CAD risk was driven by CAC rather than radiation dose. CAC was associated with poorer overall survival. Median MHD for the whole cohort was 1.25 Gy (IQR:1.01-1.56) CONCLUSION: AS from planning CT-scans predicted CAD risk and overall survival in breast cancer patients receiving radiotherapy. The MHD remained the strongest predictor in patients with low CAC. For patients with high CAC, the high baseline risk from CAC was a stronger risk factor than the dose-related risk.
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 © 2024. Published by Elsevier B.V.)
Databáze: MEDLINE
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