Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden
Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden
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DOI：
10.1016/j.radonc.2011.06.016
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发表时间：
2011-08-01
影响因子：
5.7
通讯作者：
Ewertz, Marianne
中科院分区：
文献类型：
--
作者：
McGale, Paul;Darby, Sarah C.;Ewertz, Marianne
目的：研究在随访长达30年的大量乳腺癌患者中辐射相关心脏病的发生率。材料和方法：1976年至2006年期间，丹麦或瑞典72,134名被诊断为乳腺癌的妇女进行了前瞻性随访。通过比较患左侧和右侧肿瘤的女性，研究了与辐射相关的风险。结果：34,825名女性（48%）接受放疗。在未接受放射治疗的妇女中，肿瘤的偏侧性与心脏病的相关性很小。在接受过辐射的女性中，左侧肿瘤对整个心脏的平均剂量为6.3 Gy，右侧肿瘤对整个心脏的平均剂量为2.7 Gy。在患有左、右侧肿瘤的受辐射妇女中，死亡率相似，但左、右侧的发病率比升高：急性心肌梗死1.22 (95% CI 1.06-1.42)，心绞痛1.25 (95% CI 1.05-1.49)，心包炎1.61 (95% CI 1.06-2.43)，瓣膜性心脏病1.54（1.11-2.13）。自1990年以来接受放射治疗的妇女的所有心脏病发病率比（1.09[1.00-1.19]）与1976-1989年期间接受放射治疗的妇女的发病率比（1.08[0.99-1.17]）一样高，在患乳腺癌之前诊断为缺血性心脏病的妇女的发病率比其他妇女高（1.58[1.19-2.10]对1.08 [1.01-1.15]，p差异= 0.01）。结论：至少直到最近，乳腺癌放疗增加了发生缺血性心脏病、心包炎和瓣膜病的风险。在乳腺癌诊断前患有缺血性心脏病的女性可能比其他人患乳腺癌的风险更高。2011爱思唯尔爱尔兰有限公司版权所有。放射治疗与肿瘤100 (2011)167-175
Purpose: To study incidence of radiation-related heart disease in a large population of breast cancer patients followed for up to 30 years.Material and methods: 72,134 women diagnosed with breast cancer in Denmark or Sweden during 1976-2006 and followed prospectively. Radiation-related risk was studied by comparing women with left-sided and right-sided tumours.Results: 34,825 women (48%) received radiotherapy. Among unirradiated women tumour laterality had little relevance to heart disease. Among irradiated women mean dose to the whole heart was 6.3 Gy for left-sided tumours and 2.7 Gy for right-sided tumours. Mortality was similar in irradiated women with left-sided and right-sided tumours, but incidence ratios, left-sided versus right-sided, were raised: acute myocardial infarction 1.22 (95% CI 1.06-1.42), angina 1.25 (1.05-1.49), pericarditis 1.61 (1.06-2.43), valvular heart disease 1.54 (1.11-2.13). Incidence ratios for all heart disease were as high for women irradiated since 1990 (1.09 [1.00-1.19]) as for women irradiated during 1976-1989 (1.08 [0.99-1.17]), and were higher for women diagnosed with ischaemic heart disease prior to breast cancer than for other women (1.58 [1.19-2.10] versus 1.08 [1.01-1.15], p for difference = 0.01).Conclusions: Breast cancer radiotherapy has, at least until recently, increased the risk of developing ischaemic heart disease, pericarditis and valvular disease. Women with ischaemic heart disease before breast cancer diagnosis may have incurred higher risks than others. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 100 (2011) 167-175