Long-term safety of radiotherapy and breast cancer laterality in older survivors.
Long-term safety of radiotherapy and breast cancer laterality in older survivors.
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DOI：
10.1158/1055-9965.epi-11-0348
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发表时间：
2011-10
期刊：
影响因子：
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通讯作者：
Quinn VP
中科院分区：
文献类型：
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作者：
Haque R;Yood MU;Geiger AM;Kamineni A;Avila CC;Shi J;Silliman RA;Quinn VP
尽管乳腺癌手术后辅助放疗（RT）可提高总体生存率，但其对老年幸存者心血管健康的长期不利影响仍存在争议。确定心血管疾病（CVD）的发生是否与RT相关，以及肿瘤的侧边性是否改变了这种关联。在1990年至1994年期间，65岁以上被诊断为ⅰ期和ⅱ期乳腺癌的妇女从三个健康计划中确定。这些女性通过心血管疾病结果、健康计划退出、死亡或研究结束（2004年12月31日）进行跟踪。主要的自变量是RT的使用。校正后的hr和95% ci使用Cox比例风险模型与时间相关的他莫昔芬和RT使用情况进行估计。我们调整了年龄、种族、分期、雌激素受体/孕激素受体、高血压和糖尿病。在整个队列中（N = 806）， RT与CVD风险增加无关（最长随访时间为14年）。然而，在rt暴露组（N = 340）中，与右侧肿瘤患者相比，左侧乳腺癌患者的CVD结局风险显著增加（HR = 1.53, 95% CI: 1.06-2.21）。侧边性对于理解RT对CVD的影响至关重要。对接受放射治疗的更现代女性队列的研究应纳入这一变量，以确定风险是否随着放射治疗剂量和递送的改进而持续存在。由于即使使用先进的现代放射治疗技术，对心脏的一些照射也是不可避免的，因此需要继续努力将这种暴露最小化，特别是对于患有左侧肿瘤的老年妇女。
Although adjuvant radiotherapy (RT) following surgery for breast cancer improves overall survival, controversy exists about its long-term adverse impact on cardiovascular health in older survivors. To determine whether incident cardiovascular disease (CVD) is associated with RT and whether tumor laterality modifies this association. Women aged 65+ years diagnosed with stage I and II breast cancer between 1990 and 1994 were identified from three health plans. Women were followed through CVD outcomes, health plan disenrollment, death, or study end (December 31, 2004). The main independent variable was RT use. Adjusted HRs and 95% CIs were estimated using Cox proportional hazards models with time-dependent tamoxifen and RT use status. We adjusted for age, race, stage, estrogen receptor/progesterone receptor, hypertension, and diabetes. In the full cohort (N = 806), RT was not associated with greater risk of CVD (maximum follow-up was 14 years). However, within the RT-exposed group (N = 340), women treated for left-side breast cancer had a significant increased risk of CVD outcomes (HR = 1.53, 95% CI: 1.06–2.21) compared with women with right-sided tumors. Laterality is critical to understanding the effect of RT on CVD. Studies of more contemporary cohorts of women treated with RT should incorporate this variable to determine whether the risk persists with refinements in the dosing and delivery of RT. As some irradiation to the heart is unavoidable even with refined modern RT techniques, continued effort is required to minimize such exposures, especially in older women with left-sided tumors.