No Increased Cardiac Mortality or Morbidity of Radiation Therapy in Breast Cancer Patients After Breast-Conserving Surgery: 20-Year Follow-up of the Randomized SweBCGRT Trial
| Autor: | Dan Lundstedt, Elisabeth Kjellén, Per Nilsson, Fredrika Killander, Per-Uno Malmström, Linda Werner, Erik Holmberg, Lars Holmberg, Sasha Koul, Per Karlsson, Mahnaz Haghanegi, Elinore Wieslander |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Organs at Risk Cancer Research medicine.medical_specialty Side effect medicine.medical_treatment Diagnostic Techniques Cardiovascular Urology Breast Neoplasms Mastectomy Segmental 030218 nuclear medicine & medical imaging law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Breast cancer Whole Breast Irradiation Randomized controlled trial law medicine Breast-conserving surgery Humans Radiology Nuclear Medicine and imaging Cumulative incidence Lung cancer Aged Randomized Controlled Trials as Topic Aged 80 and over Radiation business.industry Middle Aged medicine.disease Stroke Radiation therapy Oncology Cardiovascular Diseases 030220 oncology & carcinogenesis Female Morbidity business Follow-Up Studies |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 107:701-709 |
| ISSN: | 0360-3016 |
| Popis: | Purpose Radiation therapy (RT) after breast-conserving surgery reduces locoregional recurrences and improves survival but may cause late side effects. The main purpose of this paper was to investigate long-term side effects after whole breast RT in a randomized clinical trial initiated in 1991 and to report dose-volume data based on individual 3-dimensional treatment plans for organs at risk. Methods and Materials The trial included 1187 patients with T1-2 N0 breast cancer randomized to postoperative tangential whole breast RT or no further treatment. The prescription dose to the clinical target volume was 48 to 54 Gy. We present 20-year follow-up on survival, cause of death, morbidity, and later malignancies. For a cohort of patients (n = 157) with accessible computed tomography–based 3-dimensional treatment plans in Dicom-RT format, dose-volume descriptors for organs at risk were derived. In addition, these were compared with dose-volume data for a cohort of patients treated with contemporary RT techniques. Results The cumulative incidence of cardiac mortality was 12.4% in the control group and 13.0% in the RT group (P = .8). There was an increase in stroke mortality: 3.4% in the control group versus 6.7% in the RT group (P = .018). Incidences of contralateral breast cancer and lung cancer were similar between groups. The median Dmean (range) heart dose for left-sided treatments was 3.0 Gy (1.1-8.1), and the corresponding value for patients treated in 2017 was 1.5 Gy (0.4-6.0). Conclusions In this trial, serious late side effects of whole breast RT were limited and less than previously reported in large meta-analyses. We observed no increase in cardiac mortality in irradiated patients. Doses to the heart were a median Dmean of 3.0 Gy for left-sided RT. The observed increase in stroke mortality may partly be secondary to cardiac side effects, complications to anticoagulant treatment, or to chance, rather than a direct side effect of tangential whole breast irradiation. |
| Databáze: | OpenAIRE |
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