Department of Radiation Oncology, University Health Network, University of Toronto, Canada.
Radiother Oncol. 2011 Aug;100(2):184-8. doi: 10.1016/j.radonc.2011.03.009. Epub 2011 Apr 16.
To compare the coronary angiographic findings between patients who had previous left sided versus right sided breast cancer radiotherapy (RT).
Between 1995 and 2009, 12,696 patients who underwent curative RT for breast cancer at Princess Margaret Hospital were screened to assess if they had been investigated with a post-RT coronary angiogram. Two cardiologists, blinded to the laterality of radiation treatment, assessed all angiograms and measured the percentage of stenotic lesions, the mean diameters of each segment of the left anterior descending artery (LAD) and the right coronary artery (RCA) using quantitative coronary angiography (QCA).
Ninety-one patients were included, 49 patients with left sided RT and 42 with right sided RT. The median time from RT to coronary angiogram was 4.2 years (range: 22 days-16.9 years). Seventeen patients (35%) in the left sided RT group and 17 (40%) in the right sided RT group needed coronary revascularization (percutaneous coronary intervention or by-pass surgery). The LAD territory was revascularized in 12 (24%) and 11 (26%) patients, respectively. The proportion of clinically significant stenoses, degree of stenoses and mean vessel diameter were not significantly different between the two groups. In 33 patients who had coronary angiograms >5 years after breast RT (17 left-sided and 16 right-sided), the only statistically significant finding was marginally narrower mid RCA segments among those who had right sided RT: 2.52 mm versus 2.92 mm (P=0.039).
In our patients, left sided breast cancer RT did not increase the risk of coronary artery disease within the first few years, when compared to right sided RT. However, with the limitation of short duration between radiotherapy and coronary angiogram, late development of coronary artery stenoses 10-15 years after left sided RT could not be excluded.
比较曾接受左侧或右侧乳腺癌放疗（RT）的患者的冠状动脉造影结果。
在 1995 年至 2009 年间，筛选了在玛嘉烈公主医院接受根治性乳腺癌 RT 的 12696 名患者，以评估他们是否接受过 RT 后冠状动脉造影检查。两名心脏病专家在不知道放射治疗侧别的情况下评估了所有的冠状动脉造影，并使用定量冠状动脉造影术（QCA）测量左前降支（LAD）和右冠状动脉（RCA）各段狭窄病变的百分比、平均直径。
共纳入 91 例患者，其中 49 例接受左侧 RT，42 例接受右侧 RT。从 RT 到冠状动脉造影的中位时间为 4.2 年（范围：22 天-16.9 年）。左侧 RT 组 17 例（35%）和右侧 RT 组 17 例（40%）需要冠状动脉血运重建（经皮冠状动脉介入治疗或旁路手术）。分别对 12 例（24%）和 11 例（26%）患者进行了 LAD 血运重建。两组之间临床显著狭窄的比例、狭窄程度和平均血管直径均无显著差异。在 33 例接受 RT 后 5 年以上冠状动脉造影的患者（17 例左侧和 16 例右侧）中，唯一具有统计学意义的发现是右侧 RT 患者的 RCA 中段稍窄：2.52mm 与 2.92mm（P=0.039）。
在我们的患者中，与右侧 RT 相比，左侧乳腺癌 RT 在最初几年内并未增加患冠状动脉疾病的风险。然而，由于 RT 与冠状动脉造影之间的时间间隔较短，无法排除左侧 RT 后 10-15 年发生冠状动脉狭窄的晚期发展。
