Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 7/2022

Open Access 07-04-2022 | Angiography | Original Article

Risk of coronary stenosis after adjuvant radiotherapy for breast cancer

Authors: A.-K. Wennstig, PhD MD, H. Garmo, L. Wadsten, B. Lagerqvist, I. Fredriksson, L. Holmberg, C. Blomqvist, G. Nilsson, M. Sund

Published in: Strahlentherapie und Onkologie | Issue 7/2022

Login to get access

Abstract

Purpose

Adjuvant radiotherapy (RT) for breast cancer is associated with an increased risk of ischemic heart disease. We examined the risk of coronary artery stenosis in a large cohort of women with breast cancer receiving adjuvant RT.

Methods

A cohort of women diagnosed with breast cancer between 1992 and 2012 in three Swedish health care regions (n = 57,066) were linked to the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) to identify women receiving RT who subsequently underwent a percutaneous coronary intervention (PCI) due to coronary stenosis. Cox regression analyses were performed to examine risk of a coronary intervention and competing risk analyses were performed to calculate cumulative incidence.

Results

A total of 649 women with left-sided breast cancer and 494 women with right-sided breast cancer underwent a PCI. Women who received left-sided RT had a significantly higher risk of a PCI in the left anterior descending artery (LAD) compared to women who received right-sided RT, hazard ratio (HR) 1.44 (95% confidence interval [CI] 1.21–1.77, p < 0.001). For the proximal, mid, and distal LAD, the HRs were 1.60 (95% CI 1.22–2.10), 1.38 (95% CI 1.07–1.78), and 2.43 (95% CI 1.33–4.41), respectively. The cumulative incidence of coronary events at 25 years from breast cancer diagnosis were 7.0% in women receiving left-sided RT and 4.4% in women receiving right-sided RT.

Conclusion

Implementing and further developing techniques that lower cardiac doses is important in order to reduce the risk of long-term side effects of adjuvant RT for breast cancer.
Appendix
Available only for authorised users
Literature
1.
McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM et al (2011) Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol 100(2):167–175CrossRef
2.
Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106CrossRef
3.
Early Breast Cancer Trialists’ Collaborative Group (2000) Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 355(9217):1757–1770CrossRef
4.
Hooning MJ, Aleman BM, van Rosmalen AJ, Kuenen MA, Klijn JG, van Leeuwen FE (2006) Cause-specific mortality in long-term survivors of breast cancer: A 25-year follow-up study. Int J Radiat Oncol Biol Phys 64(4):1081–1091CrossRef
5.
Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716CrossRef
6.
7.
Henson KE, McGale P, Taylor C, Darby SC (2013) Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer 108(1):179–182CrossRef
8.
Paszat LF, Mackillop WJ, Groome PA, Boyd C, Schulze K, Holowaty E (1998) Mortality from myocardial infarction after adjuvant radiotherapy for breast cancer in the surveillance, epidemiology, and end-results cancer registries. J Clin Oncol 16(8):2625–2631CrossRef
9.
Milo MLH, Thorsen LBJ, Johnsen SP, Nielsen KM, Valentin JB, Alsner J et al (2021) Risk of coronary artery disease after adjuvant radiotherapy in 29,662 early breast cancer patients: a population-based Danish Breast Cancer Group study. Radiother Oncol 157:106–113CrossRef
10.
Boero IJ, Paravati AJ, Triplett DP, Hwang L, Matsuno RK, Gillespie EF et al (2016) Modern radiation therapy and cardiac outcomes in breast cancer. Int J Radiat Oncol Biol Phys 94(4):700–708CrossRef
11.
Wennstig AK, Wadsten C, Garmo H, Fredriksson I, Blomqvist C, Holmberg L et al (2020) Long-term risk of ischemic heart disease after adjuvant radiotherapy in breast cancer: results from a large population-based cohort. Breast Cancer Res 22(1):10CrossRef
12.
Rehammar JC, Jensen MB, McGale P, Lorenzen EL, Taylor C, Darby SC et al (2017) Risk of heart disease in relation to radiotherapy and chemotherapy with anthracyclines among 19,464 breast cancer patients in Denmark, 1977–2005. Radiother Oncol 123(2):299–305CrossRef
13.
Correa CR, Litt HI, Hwang WT, Ferrari VA, Solin LJ, Harris EE (2007) Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol 25:3031–3037CrossRef
14.
Nilsson G, Holmberg L, Garmo H, Duvernoy O, Sjogren I, Lagerqvist B et al (2012) Distribution of coronary artery stenosis after radiation for breast cancer. J Clin Oncol 30:380–386CrossRef
15.
Wennstig AK, Garmo H, Isacsson U, Gagliardi G, Rintela N, Lagerqvist B et al (2019) The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors. Radiat Oncol 14(1):40CrossRef
16.
Moignier A, Broggio D, Derreumaux S, Beaudre A, Girinsky T, Paul JF et al (2015) Coronary stenosis risk analysis following Hodgkin lymphoma radiotherapy: a study based on patient specific artery segments dose calculation. Radiother Oncol 117(3):467–472CrossRef
17.
18.
Taylor CW, Povall JM, McGale P, Nisbet A, Dodwell D, Smith JT et al (2008) Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Radiat Oncol Biol Phys 72(2):501–507CrossRef
19.
Taylor CW, Nisbet A, McGale P, Goldman U, Darby SC, Hall P et al (2009) Cardiac doses from Swedish breast cancer radiotherapy since the 1950s. Radiother Oncol 90:127–135CrossRef
20.
Taylor CW, Wang Z, Macaulay E, Jagsi R, Duane F, Darby SC (2015) Exposure of the heart in breast cancer radiation therapy: a systematic review of heart doses published during 2003 to 2013. Int J Radiat Oncol Biol Phys 93(4):845–853CrossRef
21.
Bartlett FR, Donovan EM, McNair HA, Corsini LA, Colgan RM, Evans PM et al (2017) The UK heartspare study (stage II): multicentre evaluation of a voluntary breath-hold technique in patients receiving breast radiotherapy. Clin Oncol 29(3):e51–e56CrossRef
22.
Jacob S, Camilleri J, Derreumaux S, Walker V, Lairez O, Lapeyre M et al (2019) Is mean heart dose a relevant surrogate parameter of left ventricle and coronary arteries exposure during breast cancer radiotherapy: a dosimetric evaluation based on individually-determined radiation dose (BACCARAT study). Radiat Oncol 14(1):29CrossRef
23.
Nilsson G, Witt Nystrom P, Isacsson U, Garmo H, Duvernoy O, Sjogren I et al (2016) Radiation dose distribution in coronary arteries in breast cancer radiotherapy. Acta Oncol 55(8):959–963CrossRef
24.
Lofgren L, Eloranta S, Krawiec K, Asterkvist A, Lonnqvist C, Sandelin K (2019) Validation of data quality in the Swedish National Register for Breast Cancer. BMC Public Health 19(1):495CrossRef
25.
Jernberg T, Attebring MF, Hambraeus K, Ivert T, James S, Jeppsson A et al (2010) The Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART). Heart 96(20):1617–1621CrossRef
26.
27.
Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368(11):987–998CrossRef
28.
Herrett E, Shah AD, Boggon R, Denaxas S, Smeeth L, van Staa T et al (2013) Completeness and diagnostic validity of recording acute myocardial infarction events in primary care, hospital care, disease registry, and national mortality records: cohort study. BMJ 346:f2350CrossRef
29.
Elo SL, Karlberg IH (2009) Validity and utilization of epidemiological data: a study of ischaemic heart disease and coronary risk factors in a local population. Public Health 123(1):52–57CrossRef
30.
Metadata
Title
Risk of coronary stenosis after adjuvant radiotherapy for breast cancer
Authors
A.-K. Wennstig, PhD MD
H. Garmo
L. Wadsten
B. Lagerqvist
I. Fredriksson
L. Holmberg
C. Blomqvist
G. Nilsson
M. Sund
Publication date
07-04-2022
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 7/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-022-01927-0

Other articles of this Issue 7/2022

Strahlentherapie und Onkologie 7/2022 Go to the issue

Original Article

Whole breast radiotherapy in cN0 early breast cancer patients with pathological sentinel lymph nodes (pN1mic, pN1a) without axillary dissection: preliminary results of the observational LISEN trial

Original Article

Estimation of secondary cancer projected risk after partial breast irradiation at the 1.5 T MR-linac

Abstracts

37. Jahrestagung der Österreichischen Gesellschaft für Radioonkologie, Radiobiologie und Medizinische Radiophysik

Letter to the Editor

Reply to: Longer treatment time and lower radiation doses—an alternative for Graves’ ophthalmopathy treatment

Original Article

Image-guided high-dose-rate brachytherapy for rectal cancer: technical note and first clinical experience on an organ-preserving approach

Literatur kommentiert

Einfluss der körperlichen Aktivität vor, während und nach der Chemotherapie auf die kognitive Leistungsfähigkeit bei Patientinnen mit Mammakarzinom: Ergebnisse einer prospektiven US-amerikanischen Studie