TY - JOUR
T1 - Competing risk analysis of cardiovascular disease risk in breast cancer patients receiving a radiation boost
AU - Koop, Yvonne
AU - Atsma, Femke
AU - Batenburg, Marilot C. T.
AU - Meijer, Hanneke
AU - van der Leij, Femke
AU - Gal, Roxanne
AU - van Velzen, Sanne G. M.
AU - Išgum, Ivana
AU - Vermeulen, Hester
AU - Maas, Angela H. E. M.
AU - Messaoudi, Saloua El
AU - Verkooijen, Helena M.
N1 - Publisher Copyright: © The Author(s) 2024.
PY - 2024/12/1
Y1 - 2024/12/1
N2 - Background: Thoracic radiotherapy may damage the myocardium and arteries, increasing cardiovascular disease (CVD) risk. Women with a high local breast cancer (BC) recurrence risk may receive an additional radiation boost to the tumor bed. Objective: We aimed to evaluate the CVD risk and specifically ischemic heart disease (IHD) in BC patients treated with a radiation boost, and investigated whether this was modified by age. Methods: We identified 5260 BC patients receiving radiotherapy between 2005 and 2016 without a history of CVD. Boost data were derived from hospital records and the national cancer registry. Follow-up data on CVD events were obtained from Statistics Netherlands until December 31, 2018. The relation between CVD and boost was evaluated with competing risk survival analysis. Results: 1917 (36.4%) received a boost. Mean follow-up was 80.3 months (SD37.1) and the mean age 57.8 years (SD10.7). Interaction between boost and age was observed for IHD: a boost was significantly associated with IHD incidence in patients younger than 40 years but not in patients over 40 years. The subdistribution hazard ratio (sHR) was calculated for ages from 25 to 75 years, showing a sHR range from 5.1 (95%CI 1.2–22.6) for 25-year old patients to sHR 0.5 (95%CI 0.2–1.02) for 75-year old patients. Conclusion: In patients younger than 40, a radiation boost is significantly associated with an increased risk of CVD. In absolute terms, the increased risk was low. In older patients, there was no association between boost and CVD risk, which is likely a reflection of appropriate patient selection.
AB - Background: Thoracic radiotherapy may damage the myocardium and arteries, increasing cardiovascular disease (CVD) risk. Women with a high local breast cancer (BC) recurrence risk may receive an additional radiation boost to the tumor bed. Objective: We aimed to evaluate the CVD risk and specifically ischemic heart disease (IHD) in BC patients treated with a radiation boost, and investigated whether this was modified by age. Methods: We identified 5260 BC patients receiving radiotherapy between 2005 and 2016 without a history of CVD. Boost data were derived from hospital records and the national cancer registry. Follow-up data on CVD events were obtained from Statistics Netherlands until December 31, 2018. The relation between CVD and boost was evaluated with competing risk survival analysis. Results: 1917 (36.4%) received a boost. Mean follow-up was 80.3 months (SD37.1) and the mean age 57.8 years (SD10.7). Interaction between boost and age was observed for IHD: a boost was significantly associated with IHD incidence in patients younger than 40 years but not in patients over 40 years. The subdistribution hazard ratio (sHR) was calculated for ages from 25 to 75 years, showing a sHR range from 5.1 (95%CI 1.2–22.6) for 25-year old patients to sHR 0.5 (95%CI 0.2–1.02) for 75-year old patients. Conclusion: In patients younger than 40, a radiation boost is significantly associated with an increased risk of CVD. In absolute terms, the increased risk was low. In older patients, there was no association between boost and CVD risk, which is likely a reflection of appropriate patient selection.
KW - Breast cancer
KW - Cancer therapy-related cardiac damage
KW - Cardiovascular disease
KW - Ischemic heart disease
KW - Radiation boost
KW - Radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85185117554&partnerID=8YFLogxK
U2 - 10.1186/s40959-024-00206-4
DO - 10.1186/s40959-024-00206-4
M3 - Article
C2 - 38336705
SN - 2057-3804
VL - 10
JO - Cardio-oncology (London, England)
JF - Cardio-oncology (London, England)
IS - 1
M1 - 7
ER -