Excess of cardiovascular mortality among node-negative breast cancer patients irradiated for inner-quadrant tumors

Article Article scientifique Article Excess of cardiovascular mortality among node-negative breast cancer patients irradiated for inner-quadrant tumors eng 2010 author Bouchardy Magnin Christine 27853 author Rapiti Aylward Elisabetta 134294 author Usel Massimo 22657 author Balmer Maino Sabine 62993 author Vlastos Georges 34925 author Benhamou Simone 689191 author Miralbell Raymond 116361 author Neyroud Isabelle 23009 author Verkooijen H. M. author Vinh Hung Vincent 660954 459-465 10.1093/annonc/mdp341 19703922 0923-7534 http://annonc.oxfordjournals.org/content/21/3/459.full.pdf BACKGROUND: Radiotherapy of the left breast is associated with higher cardiovascular mortality linked to cardiotoxic effect of irradiation. Radiotherapy of inner quadrants can be associated with greater heart irradiation, but no study has evaluated the effect of inner-quadrant irradiation on cardiovascular mortality. PATIENTS AND METHODS: We identified 1245 women, the majority with breast-conserving surgery, irradiated for primary node-negative breast cancer from 1980 to 2004 registered at the Geneva Cancer Registry. We compared breast cancer-specific and cardiovascular mortality between inner-quadrant (n = 393) versus outer-quadrant tumors (n = 852) by multivariate Cox regression analysis. RESULTS: After a mean follow-up of 7.7 years, 28 women died of cardiovascular disease and 91 of breast cancer. Patients with inner-quadrant tumors had a more than doubled risk of cardiovascular mortality compared with patients with outer-quadrant tumors (adjusted hazard ratio 2.5; 95% confidence interval 1.1-5.4). Risk was particularly increased in the period with higher boost irradiation. Patients with left-sided breast cancer had no excess of cardiovascular mortality compared with patients with right-sided tumors. CONCLUSIONS: Radiotherapy of inner-quadrant breast cancer is associated with an important increase of cardiovascular mortality, a possible result of higher irradiation of the heart. For patients with inner-quadrant tumors, the heart should be radioprotected. Breast Neoplasms/*radiotherapy/surgery Cardiovascular Diseases/etiology/*mortality/pathology Female Follow-Up Studies Humans Lymph Nodes/pathology Middle Aged Neoplasm Staging Radiation Injuries/etiology/*mortality/pathology Radiotherapy/adverse effects Time Factors Treatment Outcome Dewey 616.0757 Dewey 618 Dewey 613 58 Département de pédiatrie, gynécologie et obstétrique 223 62 Département de radiologie et informatique médicale 227 215 Registre genevois des tumeurs 22A12 false 1311 Epidémiologie des tumeurs 1017 277 Groupe Bouchardy Magnin Christine (Registre genevois des tumeurs) 532 413 Groupe Miralbell Raymond (radio-oncologie) 685 Annals of oncology 21 3 05b7dd06-fbd6-4c8d-a7d2-92c5ed77f4e0 Article (Published version) Restricted file1.pdf 98022 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de santé globale / Registre genevois des tumeurs

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Excess of cardiovascular mortality among node-negative breast cancer patients irradiated for inner-quadrant tumors	Annals of oncology			2010	631	1

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Balmer Maino, Sabine