Late cardiac mortality and morbidity in early-stage breast cancer patients after breast-conservation treatment.
OBJECTIVE
Several studies have reported increased cardiac mortality related to the use of left-sided breast or chest-wall irradiation. This study was undertaken as a comprehensive examination of the long-term cardiac mortality and morbidity after breast irradiation using contemporary irradiation techniques.


METHODS
The medical records of 961 consecutive patients presenting between 1977 and 1994 with stage I or II breast cancer treated with breast conservation treatment were reviewed. Data was recorded on baseline pretreatment patient, tumor and treatment characteristics and on subsequent cancer or cardiac related events. The median follow-up time was 12 years.


RESULTS
There was no difference in overall mortality from any cardiac cause (P = .25). Death from any cardiac cause occurred in 2% of right-sided patients and 3.5% of left-sided patients. However, in the second decade after treatment, there was a higher rate of cardiac deaths in left-sided patients, with a cumulative risk of 6.4% (95% CI, 3.5% to 11.5%) for left-sided compared with 3.6% (95% CI, 1.8% to 7.2%) for right-sided patients at 20 years. There were statistically higher rates of chest pain, coronary artery disease, and myocardial infarction diagnosed in left-sided patients (all P < or = .002). The presence of hypertension was associated with a higher risk of coronary artery disease in left-sided patients.


CONCLUSIONS
Irradiation to the left breast is not associated with a higher risk of cardiac death up to 20 years after treatment, but is associated with an increased rate of diagnoses of coronary artery disease and myocardial infarction compared with right breast treatment.
Harris
Eleanor E R
EE
Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. HarrisE@moffitt.usf.edu
Correa
Candace
C
Hwang
Wei-Ting
WT
Liao
Jessica
J
Litt
Harold I
HI
Ferrari
Victor A
VA
Solin
Lawrence J
LJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects / Q000528:radiation effects*; D006801:Humans; D015994:Incidence; D015412:Mastectomy, Segmental; D008499:Medical Records; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin