Loap P, Fourquet A, Kirova Y
Department of Radiation Oncology, institut Curie, Paris, France.
Department of Radiation Oncology, institut Curie, Paris, France.
Cancer Radiother. 2024 Jun;28(3):265-271. doi: 10.1016/j.canrad.2024.03.001. Epub 2024 Jun 18.
Breast-conserving surgery followed by reirradiation for a localized ipsilateral breast tumour relapse may increase the radiation dose delivered to the heart and result in a greater risk of cardiac adverse events. This study aimed to compare the incidence of cardiac mortality in patients treated for a localized ipsilateral breast tumour relapse, either with breast-conserving surgery followed by reirradiation or with total mastectomy between 2000 and 2020.
All patients treated for a primary non-metastatic breast cancer with breast-conserving surgery and adjuvant radiotherapy were identified in the Surveillance, Epidemiology, and End Results (SEER) program database, and those who subsequently experienced a localized ipsilateral breast tumour relapse treated with breast-conserving surgery and reirradiation ("BCS+ReRT" group, n=239) or with total mastectomy ("TM" group, n=3127) were included. The primary objective was to compare the cardiac mortality rate between the patients who underwent breast-conserving surgery followed by reirradiation and total mastectomy. Secondary endpoints were overall survival and cancer specific survival.
Cardiac mortality was significantly higher in patients treated with breast-conserving surgery followed by reirradiation (hazard ratio [HR]: 2.40, 95% confidence interval [95% CI]: 1.19-4.86, P=0.006) in univariate analysis; non-statistically significant differences were observed after adjusting for age, laterality and chemotherapy on multivariate analysis (HR: 1.96, 95% CI: 0.96-3.94, P=0.067), age being the only confounding factor. A non-statistically significant difference towards lower overall survival was observed in patients who had breast-conserving surgery followed by reirradiation compared with those who underwent total mastectomy (HR: 1.37, 95% CI: 0.98-1.90, P=0.066), and no differences were observed in terms of cancer specific survival (HR: 1.01, 95% CI: 0.56-1.82, P=0.965).
In this study, the incidence of cardiac mortality was low, and breast-conserving surgery followed by reirradiation did not independently increased the risk of cardiac mortality for a localized ipsilateral breast tumour relapse.
保乳手术联合再程放疗用于局部同侧乳腺肿瘤复发可能会增加心脏接受的辐射剂量，并导致发生心脏不良事件的风险更高。本研究旨在比较2000年至2020年间接受局部同侧乳腺肿瘤复发治疗的患者中，保乳手术联合再程放疗与全乳切除术患者的心脏死亡率。
在监测、流行病学和最终结果（SEER）计划数据库中确定所有接受保乳手术和辅助放疗的原发性非转移性乳腺癌患者，纳入那些随后经历局部同侧乳腺肿瘤复发并接受保乳手术联合再程放疗（“保乳手术+再程放疗”组，n=239）或全乳切除术（“全乳切除术”组，n=3127）的患者。主要目的是比较接受保乳手术联合再程放疗与全乳切除术患者的心脏死亡率。次要终点是总生存期和癌症特异性生存期。
单因素分析显示，保乳手术联合再程放疗治疗的患者心脏死亡率显著更高（风险比[HR]：2.40，95%置信区间[95%CI]：1.19-4.86，P=0.006）；多因素分析调整年龄、患侧和化疗后观察到无统计学显著差异（HR：1.96，95%CI：0.96-3.94，P=0.067），年龄是唯一的混杂因素。与接受全乳切除术的患者相比，接受保乳手术联合再程放疗的患者总生存期有降低的趋势，但无统计学显著差异（HR：1.37，95%CI：0.98-1.90，P=0.066），癌症特异性生存期方面未观察到差异（HR：1.01，95%CI：0.56-1.82，P=0.965）。
在本研究中，心脏死亡率较低，保乳手术联合再程放疗并未独立增加局部同侧乳腺肿瘤复发患者的心脏死亡风险。
