Hiltrud Merzenich1, Detlef Bartkowiak2, Heinz Schmidberger3, Marcus Schmidt4, Lukas Schwentner5, Thomas Wiegel2, Achim Woeckel5,6, Daniel Wollschläger7, Maria Blettner7. 1. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, 55101, Mainz, Germany. hiltrud.merzenich@unimedizin-mainz.de. 2. Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. 3. Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, 55101, Mainz, Germany. 4. Department of Obstetrics and Gynecology, University Medical Center Mainz, 55101, Mainz, Germany. 5. Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany. 6. University Hospital Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany. 7. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, 55101, Mainz, Germany.
Abstract
PURPOSE: In breast cancer patients treated in the 1970s and 1980s, radiation therapy (RT) for left-sided tumors has been associated with an elevated risk of cardiac mortality. In recent years, improved RT techniques have reduced radiation exposure of the heart and major coronary vessels, but some exposure remains unavoidable. In a retrospective cohort study, we investigated the long-term cardiac mortality risk of breast cancer survivors treated with modern RT in Germany. METHODS: A total of 11,982 women were included who were treated for breast cancer between 1998 and 2008. A systematic mortality follow-up was conducted until December 2012. The effect of breast cancer laterality on cardiac mortality and on overall mortality was investigated as a surrogate measure of exposure. Using Cox regression, we analyzed survival time as the primary outcome measure, taking potential confounding factors into account. RESULTS: We found no evidence for an effect of tumor laterality on mortality in irradiated patients (N = 9058). For cardiac mortality, the hazard ratio was 0.94 (95% CI 0.64-1.38) for left-sided versus right-sided tumors. For all causes of death, the hazard ratio was 0.95 (95% CI 0.85-1.05). A diagnosis of cardiac illness prior to breast cancer treatment increased both cardiac mortality risk and overall mortality risk. CONCLUSIONS: Contemporary RT seems not to be associated with an increased risk of cardiac mortality or overall mortality for left-sided breast cancer relative to right-sided RT. However, an extended follow-up period and exact dosimetry might be necessary to confirm this observation.
PURPOSE: In breast cancerpatients treated in the 1970s and 1980s, radiation therapy (RT) for left-sided tumors has been associated with an elevated risk of cardiac mortality. In recent years, improved RT techniques have reduced radiation exposure of the heart and major coronary vessels, but some exposure remains unavoidable. In a retrospective cohort study, we investigated the long-term cardiac mortality risk of breast cancer survivors treated with modern RT in Germany. METHODS: A total of 11,982 women were included who were treated for breast cancer between 1998 and 2008. A systematic mortality follow-up was conducted until December 2012. The effect of breast cancer laterality on cardiac mortality and on overall mortality was investigated as a surrogate measure of exposure. Using Cox regression, we analyzed survival time as the primary outcome measure, taking potential confounding factors into account. RESULTS: We found no evidence for an effect of tumor laterality on mortality in irradiated patients (N = 9058). For cardiac mortality, the hazard ratio was 0.94 (95% CI 0.64-1.38) for left-sided versus right-sided tumors. For all causes of death, the hazard ratio was 0.95 (95% CI 0.85-1.05). A diagnosis of cardiac illness prior to breast cancer treatment increased both cardiac mortality risk and overall mortality risk. CONCLUSIONS: Contemporary RT seems not to be associated with an increased risk of cardiac mortality or overall mortality for left-sided breast cancer relative to right-sided RT. However, an extended follow-up period and exact dosimetry might be necessary to confirm this observation.
Entities:
Keywords:
3D conformal radiotherapy; Breast cancer; Cardiac mortality; Cohort study
Authors: Eva Lorenz; Maria Blettner; Björn Lange; Marcus Schmidt; Astrid Schneider; Lukas Schwentner; Daniel Wollschläger; Hiltrud Merzenich Journal: Breast Care (Basel) Date: 2018-03-29 Impact factor: 2.860
Authors: S A M Gernaat; P J Ho; N Rijnberg; M J Emaus; L M Baak; M Hartman; D E Grobbee; H M Verkooijen Journal: Breast Cancer Res Treat Date: 2017-05-13 Impact factor: 4.872
Authors: Hiltrud Merzenich; Dan Baaken; Marcus Schmidt; Inga Bekes; Lukas Schwentner; Wolfgang Janni; Achim Woeckel; Detlef Bartkowiak; Thomas Wiegel; Maria Blettner; Daniel Wollschläger; Heinz Schmidberger Journal: Breast Cancer Res Treat Date: 2021-10-09 Impact factor: 4.872
Authors: C Simonetto; H Rennau; J Remmele; S Sebb; P Kundrát; M Eidemüller; U Wolf; G Hildebrandt Journal: Strahlenther Onkol Date: 2018-10-22 Impact factor: 3.621
Authors: Won Kyung Cho; Won Park; Doo Ho Choi; Hyejung Cha; Seok Jin Nam; Seok Won Kim; Jeong Eon Lee; Jonghan Yu; Young-Hyuck Im; Jin Seok Ahn; Yeon Hee Park; Ji-Yeon Kim Journal: J Breast Cancer Date: 2018-06-20 Impact factor: 3.588
Authors: Ana Aurora Díaz Gavela; Blanca Vaquero Barrón; Elia Del Cerro Peñalver; Felipe Couñago Journal: Transl Cancer Res Date: 2020-01 Impact factor: 1.241