Wang Wei, O'Connell Dianne, Stuart Kirsty, Boyages John
Westmead Breast Cancer Institute, University of Sydney, Australia.
J Med Imaging Radiat Oncol. 2011 Oct;55(5):516-25. doi: 10.1111/j.1754-9485.2011.02304.x.
The objective of this study is to assess cause-specific mortality for patients with breast cancer and to determine if excess cardiac death was associated with radiation therapy (RT).
We obtained 10-year cause-specific mortality information from the New South Wales (NSW) Central Cancer Registry and National Death Index on 1242 patients with unilateral stage I-III invasive breast cancer in NSW, Australia, diagnosed over a 6-month period in 1995. We compared actuarial cause-specific mortality (breast cancer, cardiac, other cancers and other causes) for patients who received left-sided, right-sided or no RT.
Mortality due to breast cancer or due to other cancers was not significantly different (P=0.30 and P=0.11) between the three subgroups. Mortality due to cardiac and other causes was higher in patients who did not have radiotherapy (P=0.001 and P<0.001). A total of 52 cardiac deaths in 1242 patients (4.2%) occurred - six of 274 patients (2.2%) in the left-sided radiotherapy group, four of 245 patients (1.6%) in the right-sided radiotherapy group (P=0.63) and 42 of 723 patients (5.8%) in the no radiotherapy group. Most cardiac deaths (46 of 52 cases) occurred in patients aged 70years or older at the time of diagnosis. There were no differences in cardiac mortality between the three treatment groups for those aged 70years or older (P=0.22, log-rank test), suggesting that the higher overall cardiac mortality rate in the no-RT group is due to a higher percentage of patients aged 70years or older. Of the 10 patients who died from cardiac causes and who had received RT, none had received chemotherapy or irradiation to the internal mammary chain.
There is no excess cardiac mortality due to RT within the first decade in a population series of patients with breast cancer treated with modern radiotherapy.
本研究的目的是评估乳腺癌患者的特定病因死亡率，并确定心脏死亡增加是否与放射治疗（RT）相关。
我们从新南威尔士州（NSW）中央癌症登记处和国家死亡指数获得了1995年在澳大利亚新南威尔士州诊断出的1242例单侧I - III期浸润性乳腺癌患者的10年特定病因死亡率信息。我们比较了接受左侧、右侧或未接受放疗的患者的精算特定病因死亡率（乳腺癌、心脏、其他癌症和其他原因）。
三个亚组之间因乳腺癌或其他癌症导致的死亡率没有显著差异（P = 0.30和P = 0.11）。未接受放疗的患者因心脏和其他原因导致的死亡率更高（P = 0.001和P < 0.001）。1242例患者中共发生52例心脏死亡（4.2%）——左侧放疗组274例患者中有6例（2.2%），右侧放疗组245例患者中有4例（1.6%）（P = 0.63），未放疗组723例患者中有42例（5.8%）。大多数心脏死亡（52例中的46例）发生在诊断时年龄为70岁或以上的患者中。70岁或以上的患者在三个治疗组之间的心脏死亡率没有差异（P = 0.22，对数秩检验），这表明未放疗组总体心脏死亡率较高是由于70岁或以上患者的比例较高。在10例因心脏原因死亡且接受过放疗的患者中，没有患者接受过化疗或内乳链照射。
在接受现代放疗的乳腺癌患者人群系列中，放疗后第一个十年内不存在心脏死亡率过高的情况。
