Borger Jacques H, Hooning Maartje J, Boersma Liesbeth J, Snijders-Keilholz Antonia, Aleman Berthe M P, Lintzen Eelke, van Brussel Sara, van der Toorn Peter-Paul, Alwhouhayb Maitham, van Leeuwen Flora E
Maastricht Radiation Oncology Clinic, Maastricht, The Netherlands.
Int J Radiat Oncol Biol Phys. 2007 Nov 15;69(4):1131-8. doi: 10.1016/j.ijrobp.2007.04.042. Epub 2007 Jul 2.
To assess the risk of cardiovascular disease (CVD) after postlumpectomy irradiation restricted to tangential fields.
We assessed the incidence of CVD in 1601 patients with T1-2N0 breast cancer (BC) treated with breast tangentials in five different hospitals between 1980 and 1993. Patients treated with radiation fields other than breast tangentials and those treated with adjuvant chemotherapy were excluded. For patients with left-sided BC, maximum heart distance (MHD) was measured on the simulator films as a proxy for irradiated heart volume. Risk of CVD by laterality and MHD categories was evaluated by Cox proportional hazards regression analysis.
Follow-up was complete for 94% of the patients, and median follow-up was 16 years. The incidence of CVD overall was 14.1%, of ischemic heart disease 7.3%, and for other types of heart disease 9.2%, with a median time to event of 10 to 11 years. The incidence of CVD was 11.6% in patients with right-sided BC, compared with 16.0% in left-sided cases. The hazard ratio associated with left-sided vs. right-sided BC was 1.38 (95% confidence interval [CI], 1.05-1.81) for CVD overall, 1.35 (95% CI, 0.93-1.98) for ischemic heart disease , and 1.53 (95% CI, 1.09-2.15) for other heart disease, adjusted for age, diabetes, and history of CVD. The risk of CVD did not significantly increase with increasing MHD.
Patients irradiated for left-sided BC with tangential fields have a higher incidence of CVD compared with those with right-sided cancer. However, the risk does not seem to increase with larger irradiated heart volumes.
评估仅接受切线野照射的保乳术后心血管疾病（CVD）风险。
我们评估了1980年至1993年间在五家不同医院接受乳腺切线野治疗的1601例T1-2N0乳腺癌（BC）患者的CVD发病率。排除接受乳腺切线野以外照射野治疗的患者以及接受辅助化疗的患者。对于左侧BC患者，在模拟定位片上测量最大心脏距离（MHD）作为照射心脏体积的替代指标。通过Cox比例风险回归分析评估按左右侧及MHD类别划分的CVD风险。
94%的患者完成随访，中位随访时间为16年。总体CVD发病率为14.1%，缺血性心脏病发病率为7.3%，其他类型心脏病发病率为9.2%，事件发生的中位时间为10至11年。右侧BC患者的CVD发病率为11.6%，左侧患者为16.0%。校正年龄、糖尿病和CVD病史后，左侧与右侧BC相比，总体CVD的风险比为1.38（95%置信区间[CI]，1.05 - 1.81），缺血性心脏病为1.35（95% CI，0.93 - 1.98），其他心脏病为1.53（95% CI，1.09 - 2.15）。CVD风险并未随MHD增加而显著升高。
与右侧乳腺癌患者相比，接受左侧BC切线野照射的患者CVD发病率更高。然而，风险似乎并未随照射心脏体积增大而增加。
