PMID- 35807180
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 11
IP  - 13
DP  - 2022 Jul 4
TI  - Oncological Benefit versus Cardiovascular Risk in Breast Cancer Patients Treated 
      with Modern Radiotherapy.
LID - 10.3390/jcm11133889 [doi]
LID - 3889
AB  - 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((R)) 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((R)) (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.
FAU - Acevedo, Francisco
AU  - Acevedo F
AD  - Department of Hematology-Oncology, School of Medicine, Pontificia Universidad 
      Catolica de Chile, Santiago 8330077, Chile.
FAU - Ip, Teresa
AU  - Ip T
AD  - Maule Health Service, Talca Hospital, Talca 3460001, Chile.
FAU - Orellana, Maria
AU  - Orellana M
AD  - Department of Hematology-Oncology, School of Medicine, Pontificia Universidad 
      Catolica de Chile, Santiago 8330077, Chile.
FAU - Martinez, Gonzalo
AU  - Martinez G
AUID- ORCID: 0000-0002-7120-855X
AD  - Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad 
      Catolica de Chile, Santiago 8330077, Chile.
AD  - Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380000, Chile.
FAU - Gabrielli, Luigi
AU  - Gabrielli L
AD  - Division of Cardiovascular Diseases, School of Medicine, Pontificia Universidad 
      Catolica de Chile, Santiago 8330077, Chile.
AD  - Advanced Center for Chronic Diseases (ACCDiS), Santiago 8380000, Chile.
FAU - Andia, Marcelo
AU  - Andia M
AUID- ORCID: 0000-0002-1251-5832
AD  - Department of Radiology, School of Medicine, Pontificia Universidad Catolica de 
      Chile, Marcoleta 377, Santiago 8320000, Chile.
AD  - Millennium Institute for Intelligent Healthcare & Engineering (ANID), Vicuna 
      Mackenna 4860, Macul, Santiago 7820436, Chile.
FAU - Besa, Cecilia
AU  - Besa C
AD  - Department of Radiology, School of Medicine, Pontificia Universidad Catolica de 
      Chile, Marcoleta 377, Santiago 8320000, Chile.
AD  - Millennium Institute for Intelligent Healthcare & Engineering (ANID), Vicuna 
      Mackenna 4860, Macul, Santiago 7820436, Chile.
FAU - Pinto, Mauricio P
AU  - Pinto MP
AUID- ORCID: 0000-0003-2484-8033
AD  - Department of Hematology-Oncology, School of Medicine, Pontificia Universidad 
      Catolica de Chile, Santiago 8330077, Chile.
FAU - Sanchez, Cesar
AU  - Sanchez C
AUID- ORCID: 0000-0001-7512-6474
AD  - Department of Hematology-Oncology, School of Medicine, Pontificia Universidad 
      Catolica de Chile, Santiago 8330077, Chile.
FAU - Merino, Tomas
AU  - Merino T
AD  - Department of Hematology-Oncology, School of Medicine, Pontificia Universidad 
      Catolica de Chile, Santiago 8330077, Chile.
LA  - eng
GR  - 11190071/FONDECYT Initiation/
PT  - Journal Article
DEP - 20220704
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC9267636
OTO - NOTNLM
OT  - breast cancer
OT  - cardio-oncology
OT  - cardiovascular disease
OT  - radiotherapy
COIS- The authors declare no conflict of interest.
EDAT- 2022/07/10 06:00
MHDA- 2022/07/10 06:01
PMCR- 2022/07/04
CRDT- 2022/07/09 01:17
PHST- 2022/05/24 00:00 [received]
PHST- 2022/06/22 00:00 [revised]
PHST- 2022/06/26 00:00 [accepted]
PHST- 2022/07/09 01:17 [entrez]
PHST- 2022/07/10 06:00 [pubmed]
PHST- 2022/07/10 06:01 [medline]
PHST- 2022/07/04 00:00 [pmc-release]
AID - jcm11133889 [pii]
AID - jcm-11-03889 [pii]
AID - 10.3390/jcm11133889 [doi]
PST - epublish
SO  - J Clin Med. 2022 Jul 4;11(13):3889. doi: 10.3390/jcm11133889.