Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer

作者：Sarah C. Darby, Marianne Ewertz, Paul McGale, Anna M. Bennet, Ulla Blom-Goldman, Dorthe Brønnum, Candace R. Correa, David J. Cutter, Giovanna Gagliardi, Bruna Gigante, Maj‐Britt Jensen, A. Nisbet, Richárd Pető, Kazem Rahimi, Carolyn Taylor, Per N Hall · 发表于：New England Journal of Medicine · 年份：2013 · DOI：10.1056/nejmoa1209825 · 被引用次数：4036 · 研究领域：Chemotherapy-induced cardiotoxicity and mitigation、Breast Cancer Treatment Studies、Cancer Risks and Factors

BACKGROUND: Radiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of ischemic heart disease is uncertain. METHODS: We conducted a population-based case-control study of major coronary events (i.e., myocardial infarction, coronary revascularization, or death from ischemic heart disease) in 2168 women who underwent radiotherapy for breast cancer between 1958 and 2001 in Sweden and Denmark; the study included 963 women with major coronary events and 1205 controls. Individual patient information was obtained from hospital records. For each woman, the mean radiation doses to the whole heart and to the left anterior descending coronary artery were estimated from her radiotherapy chart. RESULTS: The overall average of the mean doses to the whole heart was 4.9 Gy (range, 0.03 to 27.72). Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P<0.001), with no apparent threshold. The increase started within the first 5 years after radiotherapy and continued into the third decade after radiotherapy. The proportional increase in the rate of major coronary events per gray was similar in women with and women without cardiac risk factors at the time of radiotherapy. CONCLUSIONS: Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart ...