Daniel Wollschläger1, Hiltrud Merzenich2, Lukas Schwentner3, Wolfgang Janni3, Thomas Wiegel4, Detlef Bartkowiak4, Achim Wöckel5, Marcus Schmidt6, Heinz Schmidberger7, Maria Blettner2. 1. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany. wollschlaeger@uni-mainz.de. 2. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany. 3. Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany. 4. Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. 5. Department of Gynecology and Obstetrics, University Hospital Würzburg, Josef-Schneider-Strasse 4, 97080, Würzburg, Germany. 6. Department of Obstetrics and Gynecology, University Medical Center Mainz, 55101, Mainz, Germany. 7. Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, 55101, Mainz, Germany.
Abstract
PURPOSE: Improved survival after locoregional breast cancer has increased the concern about late adverse effects after therapy. In particular, radiotherapy was identified as a risk factor for major cardiac events in women treated until the 1990s. While modern radiotherapy with computerized planning based on 3D-imaging can help spare organs at risk, heart exposure may remain substantial. In a retrospective cohort study of women treated for locoregional breast cancer, we investigated whether current radiotherapy is associated with an elevated long-term cardiac morbidity risk. METHODS: The study included 11,982 women diagnosed with breast cancer in Germany in 1998-2008. After an individual mortality follow-up, 9338 questionnaires on cardiac events before or after therapy and on associated risk factors were sent out in 2014. Based on 4434 questionnaires from women with radiotherapy, we used Cox regression to analyze the association between self-reported cardiac morbidity and breast cancer laterality as a surrogate measure of radiation exposure. RESULTS: After a median follow-up of 8.3 years, there was no significant association of tumor laterality with cardiac morbidity in irradiated patients (458 events, hazard ratio for left-sided vs. right-sided tumors 1.07, 95% CI 0.89-1.29). Significant risk factors for any cardiac event included age at diagnosis, chemotherapy, hypertension, hypercholesteremia, and chronic kidney disease. CONCLUSIONS: For contemporary radiotherapy, we found no evidence for a significantly elevated cardiac morbidity risk in left-sided versus right-sided breast cancer. Possible reasons for failing to confirm earlier reports on increased risk include shorter follow-up, application of newer radiotherapy techniques, and improved health monitoring.
PURPOSE: Improved survival after locoregional breast cancer has increased the concern about late adverse effects after therapy. In particular, radiotherapy was identified as a risk factor for major cardiac events in women treated until the 1990s. While modern radiotherapy with computerized planning based on 3D-imaging can help spare organs at risk, heart exposure may remain substantial. In a retrospective cohort study of women treated for locoregional breast cancer, we investigated whether current radiotherapy is associated with an elevated long-term cardiac morbidity risk. METHODS: The study included 11,982 women diagnosed with breast cancer in Germany in 1998-2008. After an individual mortality follow-up, 9338 questionnaires on cardiac events before or after therapy and on associated risk factors were sent out in 2014. Based on 4434 questionnaires from women with radiotherapy, we used Cox regression to analyze the association between self-reported cardiac morbidity and breast cancer laterality as a surrogate measure of radiation exposure. RESULTS: After a median follow-up of 8.3 years, there was no significant association of tumor laterality with cardiac morbidity in irradiated patients (458 events, hazard ratio for left-sided vs. right-sided tumors 1.07, 95% CI 0.89-1.29). Significant risk factors for any cardiac event included age at diagnosis, chemotherapy, hypertension, hypercholesteremia, and chronic kidney disease. CONCLUSIONS: For contemporary radiotherapy, we found no evidence for a significantly elevated cardiac morbidity risk in left-sided versus right-sided breast cancer. Possible reasons for failing to confirm earlier reports on increased risk include shorter follow-up, application of newer radiotherapy techniques, and improved health monitoring.
Entities:
Keywords:
Breast cancer; Cardiac morbidity; Cohort study; Radiotherapy
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
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