Yit Ling Fung Nelson, Ng Choon Ta, Wong Fuh Yong, Master Zubin, Zhou Siqin, Ng Wee Loon
Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.
Department of Cardiology, National Heart Centre Singapore, Singapore.
Contemp Oncol (Pozn). 2022;26(1):59-68. doi: 10.5114/wo.2022.115676. Epub 2022 Mar 30.
Left-sided breast-cancer patients treated with adjuvant radiotherapy (RT) before the 1990s were associated with increased risk of cardiac mortality. Modern RT techniques have since improved, resulting in lower radiation doses to the heart. However, concerns regarding cardiac toxicity remain. In a retrospective cohort study, we compare the ischaemic heart disease (IHD)-related mortality of left-sided versus right-sided breast-cancer patients. We present the results of the cardiac mortality and all-cause mortality risk of Asian breast-cancer survivors treated with RT in Singapore.
A total of 14,419 Asian women from a single institution were treated for breast cancer from 2000 to 2016. A systematic mortality follow-up was conducted until December 2015. The effect of breast cancer laterality on IHD-related mortality and on overall mortality was investigated. Mean heart doses were recorded for patients from 2010-2016.
In the irradiated group ( = 9556), we found no difference in IHD-related mortality or overall mortality when comparing the left- and right-sided breast cancers. The hazard ratio of cardiac mortality for left-sided versus right-sided RT was 0.94 (95% CI: 0.64-1.38). The hazard ratio for all-cause mortality was 1.03 (95% CI: 0.94-1.13).
Our study of Asian cancer patients did not reveal a significant increase in the risk of IHD-related mortality or overall mortality comparing left- vs. right-sided breast cancers in modern-era RT.
20世纪90年代以前接受辅助放疗（RT）的左侧乳腺癌患者心脏死亡风险增加。此后现代放疗技术有所改进，使心脏所受辐射剂量降低。然而，对心脏毒性的担忧依然存在。在一项回顾性队列研究中，我们比较了左侧与右侧乳腺癌患者的缺血性心脏病（IHD）相关死亡率。我们展示了新加坡接受放疗的亚洲乳腺癌幸存者的心脏死亡率和全因死亡率风险结果。
2000年至2016年，来自单一机构的总共14419名亚洲女性接受了乳腺癌治疗。进行了系统的死亡率随访直至2015年12月。研究了乳腺癌患侧对IHD相关死亡率和总体死亡率的影响。记录了2010 - 2016年患者的平均心脏剂量。
在接受放疗的组（n = 9556）中，比较左侧和右侧乳腺癌时，我们发现IHD相关死亡率或总体死亡率没有差异。左侧放疗与右侧放疗的心脏死亡风险比为0.94（95%可信区间：0.64 - 1.38）。全因死亡率的风险比为1.03（95%可信区间：0.94 - 1.13）。
我们对亚洲癌症患者的研究未发现，在现代放疗中比较左侧与右侧乳腺癌时，IHD相关死亡率或总体死亡率风险有显著增加。
