Risk of cardiotoxicity induced by adjuvant anthracycline-based chemotherapy and radiotherapy in young and old Asian women with breast cancer
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Abstract
Purpose
The risk of cardiotoxicity induced by adjuvant anthracycline-based chemotherapy (CT) and radiotherapy (RT) is yet to be investigated in a large-scale randomized controlled trial with an adequate sample size of young and old women with breast cancer.
Patients and methods
To compare the occurrence of major heart events (heart failure and coronary artery disease) in patients with breast cancer, 3489 women who underwent surgical resection of the breast tumor were retrospectively selected from the Taiwan National Health Insurance Research Database. The patients were categorized into the following groups based on their treatment modalities: group 1 (n = 1113), no treatment; group 2 (n = 646), adjuvant RT alone; group 3 (n = 705), adjuvant anthracycline-based CT alone; and group 4 (n = 1025), combined adjuvant RT and anthracycline-based CT.
Results
The mean patient age was 50.35 years. Subsequent coronary artery disease and heart failure were identified in 244 (7.0%) and 206 (5.9%) patients, respectively. All three adjuvant therapies were significant independent prognostic factors of major heart events (adjusted hazard ratio [95% confidence interval]: 1.47 [1.24–1.73]; 1.48 [1.25–1.75], and 1.92 [1.65–2.23] in groups 2, 3, and 4, respectively). In patients aged ≥50 years with breast cancer who underwent surgery, the log-rank p values of groups 2 and 3 after adjustment were 0.537 and 0.001, respectively.
Conclusion
Adjuvant RT can increase cardiotoxicity in patients with breast cancer, particularly when used in combination with anthracycline-based CT. Therefore, it should be offered with optimal heart-sparing techniques, particularly in younger patients with good prognosis and long life expectancy.
Keywords
Cardiotoxicity Breast cancer Anthracycline Radiotherapy OldAbbreviations
- aHR
Adjusted hazard ratio
- CAD
Coronary artery disease
- CI
Confidence interval
- CT
Chemotherapy
- DM
Diabetes mellitus
- HR
Hazard ratio
- HF
Heart failure
- HTN
Hypertension
- ICD-9-CM
International Classification of Diseases, Ninth Revision, Clinical Modification
- IPTW
Inverse probability of treatment weighting
- NHIRD
National Health Insurance Research Database
- RT
Radiotherapy
- SD
Standard deviation
- TIA
Transient ischemic attack
Risiko der Kardiotoxizität induziert durch adjuvante anthrazyklinbasierte Chemotherapie und Strahlentherapie bei jungen und alten asiatischen Frauen mit Brustkrebs
Zusammenfassung
Zielsetzung
Das Risiko einer Kardiotoxizität durch adjuvante anthrazyklinbasierte Chemotherapie (CT) und Strahlentherapie (RT) muss noch in einer groß angelegten randomisierten kontrollierten Studie mit einer angemessenen Stichprobe von jungen und alten Frauen mit Brustkrebs untersucht werden.
Patienten und Methoden
Um das Auftreten von schweren Herzerkrankungen (Herzinsuffizienz und koronare Herzkrankheit) bei Patientinnen mit Brustkrebs zu vergleichen, wurden 3489 Frauen, bei denen eine chirurgische Resektion des Brusttumors durchgeführt worden war, retrospektiv aus der Taiwan National Health Insurance Research Database ausgewählt. Die Patienten wurden basierend auf ihren Behandlungsmodalitäten in die folgenden Gruppen eingeteilt: Gruppe 1 (n = 1113), keine Behandlung; Gruppe 2 (n = 646), nur adjuvante RT; Gruppe 3 (n = 705), nur adjuvante anthrazyklinbasierte CT; und Gruppe 4 (n = 1025), kombinierte adjuvante RT und anthrazyklinbasierte CT.
Ergebnisse
Das durchschnittliche Patientenalter betrug 50,35 Jahre. Nachfolgende Koronararterienerkrankung und Herzinsuffizienz wurden bei 244 (7,0 %) bzw. 206 (5,9 %) Patienten festgestellt. Alle 3 adjuvanten Therapien waren signifikante unabhängige prognostische Faktoren für schwere, das Herz betreffende Zwischenfälle (bereinigtes Hazard Ratio [95%-Konfidenzintervall]: 1,47 [1,24–1,73]; 1,48 [1,25–1,75] und 1,92 [1,65–2,23] in den Gruppen 2, 3 bzw. 4). Bei Patienten im Alter von ≥50 Jahren mit Brustkrebs, die sich einer Operation unterziehen mussten, betrugen die logarithmischen p-Werte der Gruppen 2 und 3 nach Anpassung 0,537 bzw. 0,001.
Schlussfolgerung
Adjuvante RT kann die Kardiotoxizität bei Patientinnen mit Brustkrebs erhöhen, insbesondere wenn sie in Kombination mit anthrazyklinbasierter CT angewendet wird. Daher sollte sie mit optimalen herzschonenden Techniken angeboten werden, insbesondere bei jüngeren Patienten mit guter Prognose und langer Lebenserwartung.
Schlüsselwörter
Kardiotoxizität Brustkrebs Anthrazyklin Strahlentherapie AltNotes
Acknowledgements
We would like to thank Taipei Medical University for funding (108-wf-swf-09).
Author Contributions
Conception and Design: Chih-Hsin Lee, Jun-Fu Zhang and Szu-Yuan Wu; Collection and Assembly of Data: J Chih-Hsin Lee, Jun-Fu Zhang, Kevin Sheng-Po Yuan, Alexander T.H. Wu and Szu-Yuan Wu; Data Analysis and Interpretation: Chih-Hsin Lee, Jun-Fu Zhang and Szu-Yuan Wu; Administrative Support: Szu-Yuan Wu; Manuscript Writing: All authors; Final Approval of Manuscript: All authors
Funding
Taipei Medical University and Wan Fang Hospital (108-wf-swf-09)
Compliance with ethical guidelines
Conflict of interest
C.-H. Lee, J.-F. Zhang, K.S.-P. Yuan, A.T.H. Wu and S.-Y. Wu declare that they have no competing interests.
Ethical standards
Our protocols were reviewed and approved by the Institutional Review Board of Taipei Medical University (TMU-JIRB No. 201402018).
Supplementary material
References
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