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Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa)
PURPOSE: Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques reduce radiation exposure of the heart, but some exposure remains unavoidable. In a retrospective cohort study, we investigated cardi...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8758608/ https://www.ncbi.nlm.nih.gov/pubmed/34626275 http://dx.doi.org/10.1007/s10549-021-06412-3 |
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author | Merzenich, Hiltrud Baaken, Dan Schmidt, Marcus Bekes, Inga Schwentner, Lukas Janni, Wolfgang Woeckel, Achim Bartkowiak, Detlef Wiegel, Thomas Blettner, Maria Wollschläger, Daniel Schmidberger, Heinz |
author_facet | Merzenich, Hiltrud Baaken, Dan Schmidt, Marcus Bekes, Inga Schwentner, Lukas Janni, Wolfgang Woeckel, Achim Bartkowiak, Detlef Wiegel, Thomas Blettner, Maria Wollschläger, Daniel Schmidberger, Heinz |
author_sort | Merzenich, Hiltrud |
collection | PubMed |
description | PURPOSE: Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques reduce radiation exposure of the heart, but some exposure remains unavoidable. In a retrospective cohort study, we investigated cardiac mortality and morbidity of breast cancer survivors treated with recent RT in Germany. METHODS: A total of 11,982 breast cancer patients treated between 1998 and 2008 were included. A mortality follow-up was conducted until 06/2018. In order to assess cardiac morbidity occurring after breast cancer treatment, a questionnaire was sent out in 2014 and 2019. The effect of breast cancer laterality on cardiac mortality and morbidity was investigated as a proxy for radiation exposure. We used Cox Proportional Hazards regression analysis, taking potential confounders into account. RESULTS: After a median follow-up time of 11.1 years, there was no significant association of tumor laterality with cardiac mortality in irradiated patients (hazard ratio (HR) for left-sided versus right-sided tumor 1.09; 95% confidence interval (CI) 0.85–1.41). Furthermore, tumor laterality was not identified as a significant risk factor for cardiac morbidity (HR = 1.05; 95%CI 0.88–1.25). CONCLUSIONS: Even though RT for left-sided breast cancer on average incurs higher radiation dose to the heart than RT for right-sided tumors, we found no evidence that laterality is a strong risk factor for cardiac disease after contemporary RT. However, larger sample sizes, longer follow-up, detailed information on individual risk factors and heart dose are needed to assess clinically manifest late effects of current cancer therapy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10549-021-06412-3. |
format | Online Article Text |
id | pubmed-8758608 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-87586082022-01-26 Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa) Merzenich, Hiltrud Baaken, Dan Schmidt, Marcus Bekes, Inga Schwentner, Lukas Janni, Wolfgang Woeckel, Achim Bartkowiak, Detlef Wiegel, Thomas Blettner, Maria Wollschläger, Daniel Schmidberger, Heinz Breast Cancer Res Treat Epidemiology PURPOSE: Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques reduce radiation exposure of the heart, but some exposure remains unavoidable. In a retrospective cohort study, we investigated cardiac mortality and morbidity of breast cancer survivors treated with recent RT in Germany. METHODS: A total of 11,982 breast cancer patients treated between 1998 and 2008 were included. A mortality follow-up was conducted until 06/2018. In order to assess cardiac morbidity occurring after breast cancer treatment, a questionnaire was sent out in 2014 and 2019. The effect of breast cancer laterality on cardiac mortality and morbidity was investigated as a proxy for radiation exposure. We used Cox Proportional Hazards regression analysis, taking potential confounders into account. RESULTS: After a median follow-up time of 11.1 years, there was no significant association of tumor laterality with cardiac mortality in irradiated patients (hazard ratio (HR) for left-sided versus right-sided tumor 1.09; 95% confidence interval (CI) 0.85–1.41). Furthermore, tumor laterality was not identified as a significant risk factor for cardiac morbidity (HR = 1.05; 95%CI 0.88–1.25). CONCLUSIONS: Even though RT for left-sided breast cancer on average incurs higher radiation dose to the heart than RT for right-sided tumors, we found no evidence that laterality is a strong risk factor for cardiac disease after contemporary RT. However, larger sample sizes, longer follow-up, detailed information on individual risk factors and heart dose are needed to assess clinically manifest late effects of current cancer therapy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10549-021-06412-3. Springer US 2021-10-09 2022 /pmc/articles/PMC8758608/ /pubmed/34626275 http://dx.doi.org/10.1007/s10549-021-06412-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Epidemiology Merzenich, Hiltrud Baaken, Dan Schmidt, Marcus Bekes, Inga Schwentner, Lukas Janni, Wolfgang Woeckel, Achim Bartkowiak, Detlef Wiegel, Thomas Blettner, Maria Wollschläger, Daniel Schmidberger, Heinz Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa) |
title | Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa) |
title_full | Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa) |
title_fullStr | Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa) |
title_full_unstemmed | Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa) |
title_short | Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa) |
title_sort | cardiac late effects after modern 3d-conformal radiotherapy in breast cancer patients: a retrospective cohort study in germany (escara) |
topic | Epidemiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8758608/ https://www.ncbi.nlm.nih.gov/pubmed/34626275 http://dx.doi.org/10.1007/s10549-021-06412-3 |
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