Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated with Modern Radiotherapy
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 cohor...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/13/3889 |
| _version_ | 1797443038884134912 |
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| author | Francisco Acevedo Teresa Ip María Orellana Gonzalo Martínez Luigi Gabrielli Marcelo Andia Cecilia Besa Mauricio P. Pinto Cesar Sánchez Tomas Merino |
| author_facet | Francisco Acevedo Teresa Ip María Orellana Gonzalo Martínez Luigi Gabrielli Marcelo Andia Cecilia Besa Mauricio P. Pinto Cesar Sánchez Tomas Merino |
| author_sort | Francisco Acevedo |
| collection | DOAJ |
| description | 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<sup>®</sup> 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<sup>®</sup> (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. |
| first_indexed | 2024-03-09T12:50:20Z |
| format | Article |
| id | doaj.art-c8b86a43f5ac4286acd775412e7ab1f5 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T12:50:20Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-c8b86a43f5ac4286acd775412e7ab1f52023-11-30T22:08:02ZengMDPI AGJournal of Clinical Medicine2077-03832022-07-011113388910.3390/jcm11133889Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated with Modern RadiotherapyFrancisco Acevedo0Teresa Ip1María Orellana2Gonzalo Martínez3Luigi Gabrielli4Marcelo Andia5Cecilia Besa6Mauricio P. Pinto7Cesar Sánchez8Tomas Merino9Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, ChileMaule Health Service, Talca Hospital, Talca 3460001, ChileDepartment of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, ChileDivision of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, ChileDivision of Cardiovascular Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, ChileDepartment of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago 8320000, ChileDepartment of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago 8320000, ChileDepartment of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, ChileDepartment of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, ChileDepartment of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, ChileRadiotherapy (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<sup>®</sup> 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<sup>®</sup> (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.https://www.mdpi.com/2077-0383/11/13/3889radiotherapybreast cancercardio-oncologycardiovascular disease |
| spellingShingle | Francisco Acevedo Teresa Ip María Orellana Gonzalo Martínez Luigi Gabrielli Marcelo Andia Cecilia Besa Mauricio P. Pinto Cesar Sánchez Tomas Merino Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated with Modern Radiotherapy Journal of Clinical Medicine radiotherapy breast cancer cardio-oncology cardiovascular disease |
| title | Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated with Modern Radiotherapy |
| title_full | Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated with Modern Radiotherapy |
| title_fullStr | Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated with Modern Radiotherapy |
| title_full_unstemmed | Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated with Modern Radiotherapy |
| title_short | Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated with Modern Radiotherapy |
| title_sort | oncological benefit versus cardiovascular risk in breast cancer patients treated with modern radiotherapy |
| topic | radiotherapy breast cancer cardio-oncology cardiovascular disease |
| url | https://www.mdpi.com/2077-0383/11/13/3889 |
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