Vincent Koppelmans1,2,3, Kimberly D van der Willik4,5, Berthe M P Aleman6, Flora E van Leeuwen5, Maryam Kavousi4, Banafsheh Arshi4, Meike W Vernooij4,7, M Arfan Ikram4, Sanne B Schagen5,8. 1. Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. vincent.koppelmans@utah.edu. 2. Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. vincent.koppelmans@utah.edu. 3. Department of Psychiatry, University of Utah, Salt Lake City, USA. vincent.koppelmans@utah.edu. 4. Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 5. Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 6. Department of Radiation Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 7. Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands. 8. Department of Psychology, Brain and Cognition, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, The Netherlands.
Abstract
PURPOSE: Breast cancer treatment has been associated with vascular pathology. It is unclear if such treatment is also associated with long-term cerebrovascular changes. We studied the association between radiotherapy and chemotherapy with carotid pathology and brain perfusion in breast cancer survivors. METHODS: We included 173 breast cancer survivors exposed to radiotherapy and chemotherapy, assessed ± 21.2 years after cancer diagnosis, and 346 age-matched cancer-free women (1:2) selected from the population-based Rotterdam Study. Outcome measures were carotid plaque score, intima-media thickness (IMT), total cerebral blood flow (tCBF), and brain perfusion. Additionally, we investigated the association between inclusion of the carotid artery in the radiation field (no/small/large part), tumor location, and these outcome measures within cancer survivors. RESULTS: Cancer survivors had lower tCBF (- 19.6 ml/min, 95%CI - 37.3;- 1.9) and brain perfusion (- 2.5 ml/min per 100 ml, 95%CI - 4.3;- 0.7) than cancer-free women. No statistically significant group differences were observed regarding plaque score or IMT. Among cancer survivors, a large versus a small part of the carotid artery in the radiation field was associated with a higher IMT (0.05, 95%CI0.01;0.09). Also, survivors with a right-sided tumor had lower left carotid plaque score (- 0.31, 95%CI - 0.60;- 0.02) and higher brain perfusion (3.5 ml/min per 100 ml, 95%CI 0.7;6.2) than those with a left-sided tumor. CONCLUSIONS: On average two decades post-diagnosis, breast cancer survivors had lower tCBF and brain perfusion than cancer-free women. Also, survivors with a larger area of the carotid artery within the radiation field had a larger IMT. Future studies should confirm if these cerebrovascular changes underlie the frequently observed cognitive problems in cancer survivors.
PURPOSE:Breast cancer treatment has been associated with vascular pathology. It is unclear if such treatment is also associated with long-term cerebrovascular changes. We studied the association between radiotherapy and chemotherapy with carotid pathology and brain perfusion in breast cancer survivors. METHODS: We included 173 breast cancer survivors exposed to radiotherapy and chemotherapy, assessed ± 21.2 years after cancer diagnosis, and 346 age-matched cancer-free women (1:2) selected from the population-based Rotterdam Study. Outcome measures were carotid plaque score, intima-media thickness (IMT), total cerebral blood flow (tCBF), and brain perfusion. Additionally, we investigated the association between inclusion of the carotid artery in the radiation field (no/small/large part), tumor location, and these outcome measures within cancer survivors. RESULTS:Cancer survivors had lower tCBF (- 19.6 ml/min, 95%CI - 37.3;- 1.9) and brain perfusion (- 2.5 ml/min per 100 ml, 95%CI - 4.3;- 0.7) than cancer-free women. No statistically significant group differences were observed regarding plaque score or IMT. Among cancer survivors, a large versus a small part of the carotid artery in the radiation field was associated with a higher IMT (0.05, 95%CI0.01;0.09). Also, survivors with a right-sided tumor had lower left carotid plaque score (- 0.31, 95%CI - 0.60;- 0.02) and higher brain perfusion (3.5 ml/min per 100 ml, 95%CI 0.7;6.2) than those with a left-sided tumor. CONCLUSIONS: On average two decades post-diagnosis, breast cancer survivors had lower tCBF and brain perfusion than cancer-free women. Also, survivors with a larger area of the carotid artery within the radiation field had a larger IMT. Future studies should confirm if these cerebrovascular changes underlie the frequently observed cognitive problems in cancer survivors.
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