Acevedo Francisco, Ip Teresa, Orellana María, Martínez Gonzalo, Gabrielli Luigi, Andia Marcelo, Besa Cecilia, Pinto Mauricio P, Sánchez Cesar, Merino Tomas
Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile.
Maule Health Service, Talca Hospital, Talca 3460001, Chile.
J Clin Med. 2022 Jul 4;11(13):3889. doi: 10.3390/jcm11133889.
Radiotherapy (RT) is an essential part of breast cancer (BC) treatments. Unfortunately, heart exposure to radiation can also impair the long-term survival of patients. Our study aimed to quantify the oncological benefit and the cardiovascular (CV) risk associated with modern RT in a real-world cohort of BC patients. Our descriptive study enrolled BC patients who received adjuvant RT. Ten-year overall survival (OS) was estimated using Predict version 2.1 (National Health Service, London, UK). The basal risk of CV events was estimated using the American Heart Association (ACC/AHA) CV score. Treatment volumes and mean cardiac doses were obtained from RT treatment plan records. The increased risk of CV events due to RT was estimated using a model proposed by Darby. The risk of acute myocardial infarction or stroke mortality was estimated using HeartScore (European Society of Cardiology, Brussels, Belgium). A total of 256 BC patients were included in the study. The average age of patients was 57 years old (range: 25-91); 49.6% had left BC. The mean cardiac dose was 166 cGy (interquartile range (IQR) 94-273); the estimated hazard ratio (HR) for CV disease was HR 1.12 (confidence interval (CI) 1.04-1.24). The estimated baseline 10-year CV risk was 5.6% (0.2 to 51.2); CV risk increased by 0.9% (range 0.02-35.47%) after RT. The absolute risk of 10-year mortality from CV disease was 2.5% (0.1-9); RT was associated with an estimated 4.9% survival benefit (3.73-6.07) against BC death and a 0.23% (0.17-0.29) estimated increase in CV mortality. Modern RT decreased 10-year BC mortality by 4% but increased CV mortality by 0.2% in this cohort. Our findings encourage the implementation of personalized adjuvant RT treatments that balance risks and benefits to improve long-term BC patient survival.
放射治疗（RT）是乳腺癌（BC）治疗的重要组成部分。不幸的是，心脏受到辐射也会损害患者的长期生存。我们的研究旨在量化在一个真实世界的乳腺癌患者队列中，现代放射治疗带来的肿瘤学获益和心血管（CV）风险。我们的描述性研究纳入了接受辅助放疗的乳腺癌患者。使用Predict 2.1版本（英国伦敦国民健康服务体系）估计10年总生存率（OS）。使用美国心脏协会（ACC/AHA）心血管评分估计心血管事件的基础风险。从放射治疗计划记录中获取治疗体积和平均心脏剂量。使用Darby提出的模型估计因放疗导致的心血管事件风险增加。使用HeartScore（比利时布鲁塞尔欧洲心脏病学会）估计急性心肌梗死或中风死亡率的风险。该研究共纳入256例乳腺癌患者。患者的平均年龄为57岁（范围：25 - 91岁）；49.6%为左侧乳腺癌。平均心脏剂量为166 cGy（四分位间距（IQR）94 - 273）；心血管疾病的估计风险比（HR）为HR 1.12（置信区间（CI）1.04 - 1.24）。估计的基线10年心血管风险为5.6%（0.2至51.2）；放疗后心血管风险增加0.9%（范围0.02 - 35.47%）。心血管疾病10年死亡的绝对风险为2.5%（0.1 - 9）；放疗与针对乳腺癌死亡的估计4.9%（3.73 - 6.07）的生存获益以及心血管死亡率估计0.23%（0.17 - 0.29）的增加相关。在这个队列中，现代放疗使10年乳腺癌死亡率降低了4%，但心血管死亡率增加了0.2%。我们的研究结果鼓励实施个性化的辅助放疗治疗，以平衡风险和获益，从而提高乳腺癌患者的长期生存率。
