Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study
BackgroundPrevious studies suggested that radiation therapy (RT) for breast cancer (BC) can induce cardiac arrhythmias and conduction disorders. However, the association with mean heart dose and specific cardiac substructures doses was less studied.Materials and MethodsWe conducted a nested case–con...
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| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.892882/full |
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| author | Mohamed Yassir Errahmani Mohamed Yassir Errahmani Médéa Locquet Daan Spoor Gaelle Jimenez Jérémy Camilleri Marie-Odile Bernier David Broggio Virginie Monceau Jean Ferrières Juliette Thariat Serge Boveda Youlia Kirova Pierre Loap Johannes A. Langendijk Anne Crijns Sophie Jacob |
| author_facet | Mohamed Yassir Errahmani Mohamed Yassir Errahmani Médéa Locquet Daan Spoor Gaelle Jimenez Jérémy Camilleri Marie-Odile Bernier David Broggio Virginie Monceau Jean Ferrières Juliette Thariat Serge Boveda Youlia Kirova Pierre Loap Johannes A. Langendijk Anne Crijns Sophie Jacob |
| author_sort | Mohamed Yassir Errahmani |
| collection | DOAJ |
| description | BackgroundPrevious studies suggested that radiation therapy (RT) for breast cancer (BC) can induce cardiac arrhythmias and conduction disorders. However, the association with mean heart dose and specific cardiac substructures doses was less studied.Materials and MethodsWe conducted a nested case–control study based on French BC patients, enrolled in the European MEDIRAD-BRACE study (https://clinicaltrials.gov, Identifier: NCT03211442), who underwent three-dimensional conformal radiation therapy (3D-CRT) between 2009 and 2013 and were retrospectively followed until 2019. Cases were incident cases of cardiac arrhythmia. Controls without arrhythmia were selected with propensity-scored matching by age, duration of follow-up, chemotherapy, hypertension, and diabetes (ratio 1:4 or 5). Doses to the whole heart (WH), left and right atria (LA and RA), and left and right ventricles (LV and RV) were obtained after delineation with multi-atlas-based automatic segmentation.ResultsThe study included 116 patients (21 cases and 95 controls). Mean age at RT was 64 ± 10 years, mean follow-up was 7.0 ± 1.3 years, and mean interval from RT to arrhythmia was 4.3 ± 2.1 years. None of the results on association between arrhythmia and cardiac doses reached statistical significance. However, the proportion of right-sided BC was higher among patients with arrhythmia than among controls (57% vs. 51%, OR = 1.18, p = 0.73). Neither mean WH dose, nor LV, RV, and LA doses were associated with an increased risk of arrhythmia (OR = 1.00, p > 0.90). In contrast, the RA dose was slightly higher for cases compared to controls [interquartile range (0.61–1.46 Gy) vs. (0.49–1.31 Gy), p = 0.44], and a non-significant trend toward a potentially higher risk of arrhythmia with increasing RA dose was observed (OR = 1.19, p = 0.60). Subanalysis according to BC laterality showed that the association with RA dose was reinforced specifically for left-sided BC (OR = 1.76, p = 0.75), while for right-sided BC, the ratio of mean RA/WH doses may better predict arrhythmia (OR = 2.39, p = 0.35).ConclusionDespite non-significant results, our exploratory investigation on BC patients treated with RT is the first study to suggest that right-sided BC patients and the right atrium irradiation may require special attention regarding the risk of cardiac arrhythmia and conduction disorders. Further studies are needed to expand on this topic. |
| first_indexed | 2024-12-11T04:43:39Z |
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| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-11T04:43:39Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-bafedeeed9fd4feebd8c058fddcfe34a2022-12-22T01:20:33ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-07-011210.3389/fonc.2022.892882892882Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control StudyMohamed Yassir Errahmani0Mohamed Yassir Errahmani1Médéa Locquet2Daan Spoor3Gaelle Jimenez4Jérémy Camilleri5Marie-Odile Bernier6David Broggio7Virginie Monceau8Jean Ferrières9Juliette Thariat10Serge Boveda11Youlia Kirova12Pierre Loap13Johannes A. Langendijk14Anne Crijns15Sophie Jacob16Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, FranceUniversity Paris-Saclay, Gif-sur-Yvette, FranceLaboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, FranceDepartment of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, NetherlandsDepartment of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, FranceDepartment of Radiation Oncology (Oncorad), Clinique Pasteur, Toulouse, FranceLaboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, FranceDepartment of Dosimetry, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, FranceLaboratory of Radiotoxicology and Radiobiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, FranceDepartment of Cardiology and INSERM UMR 1295, Rangueil University Hospital, Toulouse, FranceDepartment of Radiotherapy, Centre de Lutte Contre le Cancer A. Baclesse, University of Caen Normandie, Caen, FranceHeart Rhythm Management Department, Clinique Pasteur, Toulouse, France0Department of Radiation Oncology, Institut Curie, Paris, France0Department of Radiation Oncology, Institut Curie, Paris, FranceDepartment of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, NetherlandsDepartment of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, NetherlandsLaboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, FranceBackgroundPrevious studies suggested that radiation therapy (RT) for breast cancer (BC) can induce cardiac arrhythmias and conduction disorders. However, the association with mean heart dose and specific cardiac substructures doses was less studied.Materials and MethodsWe conducted a nested case–control study based on French BC patients, enrolled in the European MEDIRAD-BRACE study (https://clinicaltrials.gov, Identifier: NCT03211442), who underwent three-dimensional conformal radiation therapy (3D-CRT) between 2009 and 2013 and were retrospectively followed until 2019. Cases were incident cases of cardiac arrhythmia. Controls without arrhythmia were selected with propensity-scored matching by age, duration of follow-up, chemotherapy, hypertension, and diabetes (ratio 1:4 or 5). Doses to the whole heart (WH), left and right atria (LA and RA), and left and right ventricles (LV and RV) were obtained after delineation with multi-atlas-based automatic segmentation.ResultsThe study included 116 patients (21 cases and 95 controls). Mean age at RT was 64 ± 10 years, mean follow-up was 7.0 ± 1.3 years, and mean interval from RT to arrhythmia was 4.3 ± 2.1 years. None of the results on association between arrhythmia and cardiac doses reached statistical significance. However, the proportion of right-sided BC was higher among patients with arrhythmia than among controls (57% vs. 51%, OR = 1.18, p = 0.73). Neither mean WH dose, nor LV, RV, and LA doses were associated with an increased risk of arrhythmia (OR = 1.00, p > 0.90). In contrast, the RA dose was slightly higher for cases compared to controls [interquartile range (0.61–1.46 Gy) vs. (0.49–1.31 Gy), p = 0.44], and a non-significant trend toward a potentially higher risk of arrhythmia with increasing RA dose was observed (OR = 1.19, p = 0.60). Subanalysis according to BC laterality showed that the association with RA dose was reinforced specifically for left-sided BC (OR = 1.76, p = 0.75), while for right-sided BC, the ratio of mean RA/WH doses may better predict arrhythmia (OR = 2.39, p = 0.35).ConclusionDespite non-significant results, our exploratory investigation on BC patients treated with RT is the first study to suggest that right-sided BC patients and the right atrium irradiation may require special attention regarding the risk of cardiac arrhythmia and conduction disorders. Further studies are needed to expand on this topic.https://www.frontiersin.org/articles/10.3389/fonc.2022.892882/fullbreast cancerradiation therapycardiotoxicitycardiac arrhythmiacardiac dosimetry |
| spellingShingle | Mohamed Yassir Errahmani Mohamed Yassir Errahmani Médéa Locquet Daan Spoor Gaelle Jimenez Jérémy Camilleri Marie-Odile Bernier David Broggio Virginie Monceau Jean Ferrières Juliette Thariat Serge Boveda Youlia Kirova Pierre Loap Johannes A. Langendijk Anne Crijns Sophie Jacob Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study Frontiers in Oncology breast cancer radiation therapy cardiotoxicity cardiac arrhythmia cardiac dosimetry |
| title | Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study |
| title_full | Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study |
| title_fullStr | Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study |
| title_full_unstemmed | Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study |
| title_short | Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study |
| title_sort | association between cardiac radiation exposure and the risk of arrhythmia in breast cancer patients treated with radiotherapy a case control study |
| topic | breast cancer radiation therapy cardiotoxicity cardiac arrhythmia cardiac dosimetry |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.892882/full |
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