Significant Influence of Cardiac Radiation Dose on the Risk of Cardiotoxicity in Patients Receiving Adjuvant Trastuzumab and Radiation Therapy for Breast Cancer.

IF 6.4 1区 医学 Q1 ONCOLOGY
Tae Hoon Lee, Nalee Kim, Eun Kyoung Kim, Jin Seok Ahn, Yeon Hee Park, Seok Won Kim, Jeong Eon Lee, Jonghan Yu, Byung Joo Chae, Se Kyung Lee, Won Kyung Cho, Won Park, Tae Gyu Kim, Jee Suk Chang, Haeyoung Kim
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Abstract

Purpose: This study aimed to analyze the incidence of cancer therapy-related cardiovascular toxicity (CTRCVT) and identify the radiation dosimetric and clinical risk factors for these events in patients with human epidermal growth factor receptor 2-positive breast cancer.

Methods and materials: Data from 1378 patients who were treated with curative surgery and adjuvant trastuzumab for breast cancer were retrospectively analyzed. A total of 959 patients underwent postoperative radiation therapy (RT), whereas 419 patients were managed without RT (no-RT). CTRCVT were categorized according to the time of occurrence in relation to trastuzumab as follows: during trastuzumab cycles (CTRCVT-during T) or after completing trastuzumab (CTRCVT-after T). The cardiac radiation dose was extracted from the RT plan of each individual patient. The incidence of and contributing factors for CTRCVT-during T and -after T were evaluated.

Results: After a median follow-up of 95.8 months (range, 4.3-181.1 months), 69 patients (5.0%) had experienced CTRCVT. CTRCVT-during T was detected in 41 patients (3.0%), and the 8-year rate of CTRCVT-after T was 2.2%. Of the patients developing CTRCVT-during T, 27 (2.0%) discontinued trastuzumab. The cardiac radiation doses were significantly associated with the risk of both CTRCVT-during T (odds ratio, 1.087; P = .001) and -after T (hazard ratio, 1.177; P < .001). The 8-year rates of CTRCVT-after T were not significantly different between the no-RT and RT groups (2.0% vs 2.4%, P = .956). However, the rate was significantly higher in patients with heart V25Gy ≥3% compared with those with heart V25Gy <3% (5.7% vs 1.5%, P = .019). Patients who received <17 cycles of trastuzumab had worse oncological outcomes than those who received ≥17 cycles.

Conclusions: Both CTRCVT-during T and -after T were associated with the cardiac radiation dose. Therefore, evaluation of the cardiac radiation dose is necessary to prevent early termination of trastuzumab treatment, which could lead to worse outcomes.

心脏放射剂量对接受曲妥珠单抗辅助治疗和放射治疗的乳腺癌患者心脏毒性风险的显著影响
目的:本研究旨在分析癌症治疗相关心血管毒性(CTRCVT)的发生率,并确定HER2阳性乳腺癌患者发生这些事件的放射剂量和临床风险因素:回顾性分析了1378名接受根治性手术和曲妥珠单抗辅助治疗的乳腺癌患者的数据。共有 959 名患者接受了术后放疗(RT),419 名患者未接受放疗(no-RT)。CTRCVT根据与曲妥珠单抗相关的发生时间分类如下:曲妥珠单抗周期内(CTRCVT-T期间)或曲妥珠单抗结束后(CTRCVT-T后)。心脏放射剂量从每位患者的 RT 计划中提取。评估了T期间和T之后CTRCVT的发生率和诱因:中位随访 95.8 个月(4.3-181.1 个月)后,69 例患者(5.0%)发生了 CTRCVT。41 名患者(3.0%)在 T 期间发现了 CTRCVT,T 后 8 年的 CTRCVT 发生率为 2.2%。在T期间发生CTRCVT的患者中,有27人(2.0%)停用了曲妥珠单抗。心脏放射剂量与T期间(几率比为1.087;P = 0.001)和T后(危险比为1.177;P 25Gy≥3%)发生CTRCVT的风险明显相关:T 期间和 T 之后的 CTRCVT 均与心脏辐射剂量有关。因此,有必要对心脏辐射剂量进行评估,以防止过早终止曲妥珠单抗治疗,从而导致更差的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
11.00
自引率
7.10%
发文量
2538
审稿时长
6.6 weeks
期刊介绍: International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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