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3D conformal radiotherapy is not associated with the long-term cardiac mortality in breast cancer patients: a retrospective cohort study in Germany (PASSOS-Heart Study)

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

In breast cancer patients treated in the 1970s and 1980s, radiation therapy (RT) for left-sided tumors has been associated with an elevated risk of cardiac mortality. In recent years, improved RT techniques have reduced radiation exposure of the heart and major coronary vessels, but some exposure remains unavoidable. In a retrospective cohort study, we investigated the long-term cardiac mortality risk of breast cancer survivors treated with modern RT in Germany.

Methods

A total of 11,982 women were included who were treated for breast cancer between 1998 and 2008. A systematic mortality follow-up was conducted until December 2012. The effect of breast cancer laterality on cardiac mortality and on overall mortality was investigated as a surrogate measure of exposure. Using Cox regression, we analyzed survival time as the primary outcome measure, taking potential confounding factors into account.

Results

We found no evidence for an effect of tumor laterality on mortality in irradiated patients (N = 9058). For cardiac mortality, the hazard ratio was 0.94 (95% CI 0.64–1.38) for left-sided versus right-sided tumors. For all causes of death, the hazard ratio was 0.95 (95% CI 0.85–1.05). A diagnosis of cardiac illness prior to breast cancer treatment increased both cardiac mortality risk and overall mortality risk.

Conclusions

Contemporary RT seems not to be associated with an increased risk of cardiac mortality or overall mortality for left-sided breast cancer relative to right-sided RT. However, an extended follow-up period and exact dosimetry might be necessary to confirm this observation.

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Abbreviations

CIS:

Carcinoma in situ

CI:

Confidence interval

HR:

Hazard ratio

ICD:

International classification of diseases

PY:

Person-years

RT:

Radiotherapy

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Acknowledgements

This work was supported by the German Federal Ministry of Education and Research (BMBF) with Contract No. (02NUK026B). The study sponsor had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the manuscript, or in the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, 55101, Mainz, Germany

    Hiltrud Merzenich, Daniel Wollschläger & Maria Blettner

  2. Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    Detlef Bartkowiak & Thomas Wiegel

  3. Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, 55101, Mainz, Germany

    Heinz Schmidberger

  4. Department of Obstetrics and Gynecology, University Medical Center Mainz, 55101, Mainz, Germany

    Marcus Schmidt

  5. Department of Gynecology and Obstetrics, University Hospital Ulm, Prittwitzstr. 43, 89075, Ulm, Germany

    Lukas Schwentner & Achim Woeckel

  6. University Hospital Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany

    Achim Woeckel

Authors
  1. Hiltrud Merzenich
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  2. Detlef Bartkowiak
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Correspondence to Hiltrud Merzenich.

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Merzenich, H., Bartkowiak, D., Schmidberger, H. et al. 3D conformal radiotherapy is not associated with the long-term cardiac mortality in breast cancer patients: a retrospective cohort study in Germany (PASSOS-Heart Study). Breast Cancer Res Treat 161, 143–152 (2017). https://doi.org/10.1007/s10549-016-4042-2

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  • DOI: https://doi.org/10.1007/s10549-016-4042-2

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