Supraclavicular radiation for breast cancer does not increase the 10-year risk of stroke
Supraclavicular radiation for breast cancer does not increase the 10-year risk of stroke
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DOI：
10.1002/cncr.21943
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发表时间：
2006-06-15
期刊：
影响因子：
6.2
通讯作者：
Buchholz, Thomas A.
中科院分区：
文献类型：
--
作者：
Woodward, Wendy A.;Giordano, Sharon H.;Buchholz, Thomas A.
背景。现代放射技术限制了乳腺癌治疗期间心脏的辐射剂量，大大降低了放射引起的心脏损伤的风险。然而，颈动脉的辐射损伤风险并未得到常规检查，颈动脉经常被偶然纳入乳腺癌治疗的锁骨上放射野中，并且用于治疗该区域的技术与早期放射试验相比并没有显着变化。本研究的目的是比较接受锁骨上放射治疗的乳腺癌女性与接受乳房放射治疗但未接受锁骨上窝放射治疗的女性因中风住院的发生率。方法。对 1988 年至 1997 年间被诊断患有美国癌症联合委员会 (AJCC) I-III 期非转移性乳腺癌的 5752 名女性的监测、流行病学和最终结果 (SEER)-医疗保险数据库中的数据进行了分析。纳入的女性年龄 >= 66 岁，已知淋巴结 (LN) 状态，肿瘤测量 4 个阳性 LN（锁骨上放射组的替代物，n = 471）作为中风住院终点。使用条件Kaplan-Meier 方法计算时间-事件曲线。结果。 0 和 4+ LN 队列的中位随访时间分别为 92 个月和 90 个月（至少 60 个月）。 10 年和 15 年精算中风住院率分别为 91% (0 LN) 与 89.5% (4+ LN) 和 79% (0 LN) 与 81.6% (4+ LN) (P =.28)。两个队列之间的雌激素受体状态是平衡的。正如预期的那样，4+ 队列的肿瘤更晚期、分期更高、肿瘤尺寸更大、级别更高（P
BACKGROUND. Modern radiation techniques, which limit the radiation dose to the heart during treatment for breast cancer, have greatly reduced the risk of radiation-induced cardiac injury. However, the risk of radiation damage to the carotid artery, which is often incidentally included in the supraclavicular radiation field for breast cancer treatment, is not routinely examined, and the technique used to treat this field has not changed significantly from early radiation trials. The purpose of the current study was to compare the incidence of hospitalization for stroke among women with breast cancer treated with supraclavicular radiation with those who received radiation therapy to the breast but not the supraclavicular fossa.METHODS. Data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database for 5752 women who were diagnosed with American Joint Committee on Cancer (AJCC) Stage I-III nonmetastatic breast cancer between 1988 and 1997 were analyzed. Women included were age >= 66 years, had known lymph node (LN) status, had tumors measuring 4 positive LNs (surrogate for supraclavicular radiation group, n = 471) for the endpoint of hospitalization for stroke. Time-to-event curves were calculated using the conditional Kaplan-Meier method.RESULTS. The median follow-up for the 0 and 4+ LN cohorts were 92 months and 90 months, respectively (minimum of 60 months). The 10-year and 15-year actuarial freedom from hospitalization for stroke was 91% (0 LN) versus 89.5% (4+ LN) and 79% (0 LN) versus 81.6% (4+ LN), respectively (P =.28). Estrogen receptor status was balanced between the 2 cohorts. As expected, the 4+ cohort had more advanced tumors, higher stage, larger tumor size, and higher grade (P