Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Department of Surgery, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea.
Breast Cancer Res Treat. 2017 Nov;166(1):249-257. doi: 10.1007/s10549-017-4398-y. Epub 2017 Jul 17.
To study the late cardiac toxicity of breast radiation therapy (RT) in Asian women.
Female breast cancer patients in Korea who underwent breast conservation surgery followed by RT from 1990-2012 were identified from two large registries at institution and population levels. Cumulative incidences of acute coronary events (ACE) or cardiac mortality were estimated in relation to the laterality of breast cancer using a competing risks analysis.
In an analysis of 2577 women from a single institution, 3.7% were obese (body mass index ≥30), and 3.4% were ever-smokers. Patients with a history of hypertension, diabetes, or coronary artery disease were 17.5, 5.7, and 2.8%, respectively. The mean heart doses were 6.2 and 1.5 Gy for left- and right-sided tumors, respectively. With a median follow-up of 7 (range 1-23) years, the overall and breast cancer-specific survivals at 10 years were 94.9 and 96.5%, respectively. The 10-year cumulative incidence of ACE was 2.96%. The mean time to ACE was 5.2 ± 3.9 years (range 1-17). There was no clinically relevant difference in rates of ACE between left-sided and right-sided patients, with an adjusted hazard ratio of 1.16 (CI 0.59-2.29). An analysis of 24,235 women in a nationwide registry validated these negative findings with respect to cardiac mortality, with an adjusted hazard ratio of 1.52 (CI 0.37-6.25). Increasing age, a higher body mass index, and a history of hypertension or ischemic heart disease were identified as risk factors.
Our findings reassure that excess risk from breast RT may be small in healthy women, most of who not smoke, weigh less, and have fewer risk factors. A validation using a larger data set of National Health Insurance Corporation is ongoing.
研究亚洲女性乳腺癌放射治疗（RT）的晚期心脏毒性。
从机构和人群两个层面的两个大型登记处，确定了 1990 年至 2012 年间接受保乳手术后接受 RT 的韩国女性乳腺癌患者。使用竞争风险分析，根据乳腺癌的侧别估计急性冠状动脉事件（ACE）或心脏死亡率的累积发生率。
在对来自单个机构的 2577 名女性的分析中，3.7%为肥胖（体重指数≥30），3.4%为吸烟者。有高血压、糖尿病或冠心病病史的患者分别为 17.5%、5.7%和 2.8%。左侧和右侧肿瘤的平均心脏剂量分别为 6.2 和 1.5 Gy。中位随访时间为 7 年（范围 1-23 年），10 年总生存率和乳腺癌特异性生存率分别为 94.9%和 96.5%。ACE 的 10 年累积发生率为 2.96%。ACE 的平均时间为 5.2±3.9 年（范围 1-17）。左侧和右侧患者的 ACE 发生率没有临床相关差异，调整后的危险比为 1.16（CI 0.59-2.29）。在一个全国性登记处对 24235 名女性的分析中，心脏死亡率也得到了阴性结果，调整后的危险比为 1.52（CI 0.37-6.25）。年龄较大、体重指数较高、高血压或缺血性心脏病病史被确定为危险因素。
我们的研究结果证实，在大多数不吸烟、体重较轻且危险因素较少的健康女性中，乳腺癌 RT 的额外风险可能较小。正在使用更大的国民健康保险数据进行验证。
