Seth Lakshya, Makram Omar, Essa Amr, Patel Vraj, Jiang Stephanie, Bhave Aditya, Yerraguntla Sandeep, Gopu Gaurav, Malik Sarah, Swaby Justin, Rast Johnathon, Padgett Caleb A, Shetewi Ahmed, Nain Priyanshu, Weintraub Neal, Miller Eric D, Dent Susan, Barac Ana, Shiradkar Rakesh, Madabhushi Anant, Ferguson Catherine, Guha Avirup
Department of Medicine, Medical College of Georgia, Augusta, Georgia.
Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
Adv Radiat Oncol. 2024 Jul 30;9(10):101583. doi: 10.1016/j.adro.2024.101583. eCollection 2024 Oct.
External beam radiation therapy (EBRT) is a critical component of breast cancer (BC) therapy. Given the improvement in technology in the contemporary era, we hypothesized that there is no difference in the development of or worsening of existing coronary artery disease (CAD) in patients with BC receiving left versus right-sided radiation.
For the meta-analysis portion of our study, we searched PubMed, Web of Science, and Scopus and included studies from January 1999 to September 2022. CAD was identified using a homogenous metric across multiple studies included. We computed the risk ratio (RR) for included studies using a random effects model. For the institutional cohort portion of our study, we selected high cardiovascular-risk patients who received diagnoses of BC between 2010 and 2022 if they met our inclusion criteria. We performed a Cox proportional hazards model with stepwise adjustment.
A pooled random effects model with 9 studies showed that patients with left-sided BC receiving EBRT had a 10% increased risk of CAD when compared with patients with right-sided BC receiving EBRT (RR, 1.10; 95% CI, 1.02-1.18; = .01). However, subgroup analysis of 6 studies that included patients diagnosed after 1980 did not show a significant difference in CAD based on BC laterality (RR, 1.07; 95% CI, 0.95-1.20; = .27). For the institutional cohort portion of the study, we found that patients with left-sided BC who received EBRT did not have a significantly higher risk of CAD when compared with their right-sided counterparts (hazard ratios [HR], 0.73; 95% CI, 0.34-1.54; = .402).
Our study suggests a historical trend of increased CAD in BC patients receiving left-sided EBRT. Data from patients diagnosed after 2010 in our institutional cohort did not show a significant difference emphasizing that modern EBRT regimens are safe, and laterality of BC does not affect CAD outcomes in the short term after a BC diagnosis.
外照射放疗（EBRT）是乳腺癌（BC）治疗的关键组成部分。鉴于当代技术的进步，我们假设接受左侧与右侧放疗的BC患者在现有冠状动脉疾病（CAD）的发生或恶化方面没有差异。
对于我们研究的荟萃分析部分，我们检索了PubMed、科学网和Scopus，并纳入了1999年1月至2022年9月的研究。在纳入的多项研究中，使用统一的指标来识别CAD。我们使用随机效应模型计算纳入研究的风险比（RR）。对于我们研究的机构队列部分，我们选择了2010年至2022年间被诊断为BC且符合我们纳入标准的高心血管风险患者。我们进行了逐步调整的Cox比例风险模型。
一项纳入9项研究的汇总随机效应模型显示，与接受右侧EBRT的BC患者相比，接受左侧EBRT的BC患者患CAD的风险增加了10%（RR，1.10；95%CI，1.02 - 1.18；P =.01）。然而，对6项纳入1980年后诊断患者的研究进行的亚组分析未显示基于BC侧别的CAD有显著差异（RR，1.07；95%CI，0.95 - 1.20；P =.27）。对于研究的机构队列部分，我们发现接受左侧EBRT的BC患者与右侧患者相比，患CAD的风险没有显著更高（风险比[HR]，0.73；95%CI，0.34 - 1.54；P =.402）。
我们的研究表明，接受左侧EBRT的BC患者中CAD增加存在历史趋势。我们机构队列中2010年后诊断的患者数据未显示出显著差异，强调现代EBRT方案是安全的，且BC的侧别在BC诊断后的短期内不影响CAD结局。
