Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost
Abstract Background Thoracic radiotherapy may damage the myocardium and arteries, increasing cardiovascular disease (CVD) risk. Women with a high local breast cancer (BC) recurrence risk may receive an additional radiation boost to the tumor bed. Objective We aimed to evaluate the CVD risk and speci...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Cardio-Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40959-024-00206-4 |
| _version_ | 1797273068177981440 |
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| author | Yvonne Koop Femke Atsma Marilot C.T. Batenburg Hanneke Meijer Femke van der Leij Roxanne Gal Sanne G.M. van Velzen Ivana Išgum Hester Vermeulen Angela H.E.M. Maas Saloua El Messaoudi Helena M. Verkooijen |
| author_facet | Yvonne Koop Femke Atsma Marilot C.T. Batenburg Hanneke Meijer Femke van der Leij Roxanne Gal Sanne G.M. van Velzen Ivana Išgum Hester Vermeulen Angela H.E.M. Maas Saloua El Messaoudi Helena M. Verkooijen |
| author_sort | Yvonne Koop |
| collection | DOAJ |
| description | Abstract Background Thoracic radiotherapy may damage the myocardium and arteries, increasing cardiovascular disease (CVD) risk. Women with a high local breast cancer (BC) recurrence risk may receive an additional radiation boost to the tumor bed. Objective We aimed to evaluate the CVD risk and specifically ischemic heart disease (IHD) in BC patients treated with a radiation boost, and investigated whether this was modified by age. Methods We identified 5260 BC patients receiving radiotherapy between 2005 and 2016 without a history of CVD. Boost data were derived from hospital records and the national cancer registry. Follow-up data on CVD events were obtained from Statistics Netherlands until December 31, 2018. The relation between CVD and boost was evaluated with competing risk survival analysis. Results 1917 (36.4%) received a boost. Mean follow-up was 80.3 months (SD37.1) and the mean age 57.8 years (SD10.7). Interaction between boost and age was observed for IHD: a boost was significantly associated with IHD incidence in patients younger than 40 years but not in patients over 40 years. The subdistribution hazard ratio (sHR) was calculated for ages from 25 to 75 years, showing a sHR range from 5.1 (95%CI 1.2–22.6) for 25-year old patients to sHR 0.5 (95%CI 0.2–1.02) for 75-year old patients. Conclusion In patients younger than 40, a radiation boost is significantly associated with an increased risk of CVD. In absolute terms, the increased risk was low. In older patients, there was no association between boost and CVD risk, which is likely a reflection of appropriate patient selection. |
| first_indexed | 2024-03-07T14:39:13Z |
| format | Article |
| id | doaj.art-dbcfb5f27c704e1d8987198ab37edaf4 |
| institution | Directory Open Access Journal |
| issn | 2057-3804 |
| language | English |
| last_indexed | 2024-03-07T14:39:13Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardio-Oncology |
| spelling | doaj.art-dbcfb5f27c704e1d8987198ab37edaf42024-03-05T20:29:55ZengBMCCardio-Oncology2057-38042024-02-011011910.1186/s40959-024-00206-4Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boostYvonne Koop0Femke Atsma1Marilot C.T. Batenburg2Hanneke Meijer3Femke van der Leij4Roxanne Gal5Sanne G.M. van Velzen6Ivana Išgum7Hester Vermeulen8Angela H.E.M. Maas9Saloua El Messaoudi10Helena M. Verkooijen11Department of Cardiology, Radboud University Medical CenterScientific Institute for Quality of Healthcare, Radboud University Medical CenterDepartment of Radiation Oncology, University Medical Center Utrecht, Utrecht UniversityDepartment of Radiation Oncology, Radboud University Medical CenterDepartment of Radiation Oncology, University Medical Center Utrecht, Utrecht UniversityDivision of Imaging and Oncology, University Medical Center Utrecht, Utrecht UniversityDepartment of Biomedical Engineering and Physics, Amsterdam University Medical Center, Location University of AmsterdamDepartment of Biomedical Engineering and Physics, Amsterdam University Medical Center, Location University of AmsterdamScientific Institute for Quality of Healthcare, Radboud University Medical CenterDepartment of Cardiology, Radboud University Medical CenterDepartment of Cardiology, Radboud University Medical CenterDivision of Imaging and Oncology, University Medical Center Utrecht, Utrecht UniversityAbstract Background Thoracic radiotherapy may damage the myocardium and arteries, increasing cardiovascular disease (CVD) risk. Women with a high local breast cancer (BC) recurrence risk may receive an additional radiation boost to the tumor bed. Objective We aimed to evaluate the CVD risk and specifically ischemic heart disease (IHD) in BC patients treated with a radiation boost, and investigated whether this was modified by age. Methods We identified 5260 BC patients receiving radiotherapy between 2005 and 2016 without a history of CVD. Boost data were derived from hospital records and the national cancer registry. Follow-up data on CVD events were obtained from Statistics Netherlands until December 31, 2018. The relation between CVD and boost was evaluated with competing risk survival analysis. Results 1917 (36.4%) received a boost. Mean follow-up was 80.3 months (SD37.1) and the mean age 57.8 years (SD10.7). Interaction between boost and age was observed for IHD: a boost was significantly associated with IHD incidence in patients younger than 40 years but not in patients over 40 years. The subdistribution hazard ratio (sHR) was calculated for ages from 25 to 75 years, showing a sHR range from 5.1 (95%CI 1.2–22.6) for 25-year old patients to sHR 0.5 (95%CI 0.2–1.02) for 75-year old patients. Conclusion In patients younger than 40, a radiation boost is significantly associated with an increased risk of CVD. In absolute terms, the increased risk was low. In older patients, there was no association between boost and CVD risk, which is likely a reflection of appropriate patient selection.https://doi.org/10.1186/s40959-024-00206-4RadiotherapyBreast cancerRadiation boostIschemic heart diseaseCardiovascular diseaseCancer therapy-related cardiac damage |
| spellingShingle | Yvonne Koop Femke Atsma Marilot C.T. Batenburg Hanneke Meijer Femke van der Leij Roxanne Gal Sanne G.M. van Velzen Ivana Išgum Hester Vermeulen Angela H.E.M. Maas Saloua El Messaoudi Helena M. Verkooijen Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost Cardio-Oncology Radiotherapy Breast cancer Radiation boost Ischemic heart disease Cardiovascular disease Cancer therapy-related cardiac damage |
| title | Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost |
| title_full | Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost |
| title_fullStr | Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost |
| title_full_unstemmed | Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost |
| title_short | Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost |
| title_sort | competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost |
| topic | Radiotherapy Breast cancer Radiation boost Ischemic heart disease Cardiovascular disease Cancer therapy-related cardiac damage |
| url | https://doi.org/10.1186/s40959-024-00206-4 |
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