Beaumont Hospital, Division of Cardiology, Royal Oak, Michigan.
Beaumont Hospital, Division of Cardiology, Royal Oak, Michigan.
Am J Cardiol. 2021 Mar 15;143:14-20. doi: 10.1016/j.amjcard.2020.12.038. Epub 2021 Jan 4.
Breast cancer is the most commonly diagnosed cancer in women and radiotherapy is a widely used treatment approach. However, there is an increased risk of coronary artery disease and cardiac death in women treated with radiotherapy. The present study was undertaken to clarify the relation between radiotherapy and coronary disease in women with previous breast irradiation using coronary computed tomographic angiography (CCTA). We conducted a retrospective analysis of women with a history of right or left-sided breast cancer (RBC; LBC) treated with radiotherapy who subsequently underwent CCTA. RBC patients who had reduced radiation doses to the myocardium served as controls. Patients (n = 6,593) with a history of nonmetastatic breast cancer treated with radiotherapy were screened for completion of CCTA; 49 LBC and 45 RBC women were identified. Age and risk factor matched patients with LBC had higher rates of coronary disease compared with RBC patients; left anterior descending (LAD) coronary artery (76% vs 31% [p < 0.001]), left circumflex (33% vs. 6.7% [p = 0.004]), and right coronary artery (37% vs 13% [p = 0.018]). Mean LAD radiation dose and mean heart dose strongly correlated with coronary disease, with a 21% higher incidence of disease in the LAD per Gy for mean LAD dose and a 95% higher incidence of disease in the LAD per Gy for mean heart dose. In conclusion, LBC patients treated with radiotherapy have a significantly higher incidence of coronary disease when compared with a matched group of patients treated for RBC. Radiation doses correlated with the incidence of coronary disease.
乳腺癌是女性最常见的癌症类型，放疗是一种广泛应用的治疗方法。然而，接受放疗的女性患冠状动脉疾病和心脏死亡的风险增加。本研究旨在使用冠状动脉计算机断层血管造影术（CCTA）明确既往接受过乳房放疗的女性中放疗与冠状动脉疾病之间的关系。我们对接受过右侧或左侧乳腺癌（RBC；LBC）放疗且随后接受 CCTA 的女性进行了回顾性分析。接受过心肌辐射剂量减少的 RBC 患者作为对照组。筛选出接受过放疗且患有非转移性乳腺癌的患者（n=6593），以完成 CCTA；共确定了 49 例 LBC 和 45 例 RBC 女性。与 RBC 患者相比，患有 LBC 的年龄和危险因素匹配的患者患冠状动脉疾病的比例更高；左前降支（LAD）冠状动脉（76% vs 31%[p<0.001]）、左旋支（33% vs. 6.7%[p=0.004]）和右冠状动脉（37% vs 13%[p=0.018]）。平均 LAD 辐射剂量和平均心脏剂量与冠状动脉疾病强烈相关，LAD 平均剂量每增加 1 Gy，LAD 疾病的发生率增加 21%，LAD 平均剂量每增加 1 Gy，LAD 疾病的发生率增加 95%。总之，与接受 RBC 治疗的匹配组患者相比，接受放疗的 LBC 患者患冠状动脉疾病的发生率显著更高。辐射剂量与冠状动脉疾病的发生率相关。
