Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines

被引:41
作者
Beaton, Laura [1 ]
Bergman, Alanah [2 ]
Nichol, Alan [1 ,3 ,5 ]
Aparicio, Maria [1 ]
Wong, Graham [4 ,5 ]
Gondara, Lovedeep [3 ]
Speers, Caroline [3 ]
Weir, Lorna [1 ,3 ,5 ]
Davis, Margot [4 ,5 ]
Tyldesley, Scott [1 ,3 ,5 ]
机构
[1] BC Canc Agcy, Dept Radiat Oncol, Vancouver Ctr, Vancouver, BC, Canada
[2] BC Canc Agcy, Dept Med Phys, Vancouver Ctr, Vancouver, BC, Canada
[3] BC Canc Agcy, Breast Canc Outcomes Unit, Vancouver Ctr, Vancouver, BC, Canada
[4] Vancouver Gen Hosp, Dept Cardiol, Vancouver, BC, Canada
[5] Univ British Columbia, Fac Med, Vancouver, BC, Canada
关键词
Cardiac death; Breast radiotherapy; Cardiovascular risk factors; QUANTEC guidelines; CANCER RADIOTHERAPY; HEART-DISEASE; MYOCARDIAL-INFARCTION; RADIATION-THERAPY; ADJUVANT RADIOTHERAPY; MORTALITY; WOMEN; RISK; SURGERY; MORBIDITY;
D O I
10.1016/j.ctro.2019.08.001
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Breast/chest wall irradiation (RT) increases risk of cardiovascular death. International Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines state for partial heart irradiation a "V25Gy <10% will be associated with a <1% probability of cardiac mortality" in long-term follow-up after RT. We assessed whether women treated with breast/chest wall RT 10-years ago who died of cardiovascular disease (CVD) violated QUANTEC guidelines. Materials/methods: A population-based database identified all cardiovascular deaths in women with early-stage breast cancer <80 years, treated with adjuvant breast/chest wall RT from 2002 to 2006. Ten-year rate of cardiovascular death was calculated using a Kaplan-Meier method. Patients were matched on a 2:1 basis with controls that did not die of CVD. For left-sided cases, the heart and left anterior descending (LAD) artery were retrospectively delineated. Dose-volume histograms were calculated, and heart V25Gy compared to QUANTEC guidelines. Results: 5249 eligible patients received breast/chest wall RT from 2002 to 2006: 76 (1.4% at 10-years) died of CVD by June 2015. Forty-two patients received left-sided RT (1.7% CVD death at 10-years), 34 right-sided RT (1.3% at 10-years). Heart V25Gy did not exceed 10% in any left-sided cases. No cardiac dosimetry parameter distinguished left-sided cases from controls. Conclusions: QUANTEC guidelines were not violated in any patient that died of CVD after left-sided RT. The risk of radiation induced cardiac death at 10-years appears to be very low if MHD is <3.3 Gy and maximum LAD dose (EQD2(3) Gy) is <45.4 Gy. Further studies are needed to evaluate heart and LAD constraints in the CT-planning era. (C) 2019 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.
引用
收藏
页码:39 / 45
页数:7
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