Coronary artery calcium in breast cancer survivors after radiation therapy.
The purpose of the current study is to investigate whether breast cancer survivors after radiation therapy have a higher burden of coronary artery calcium as a potential surrogate of radiation-induced accelerated coronary artery disease. 333 patients were included. 54 patients underwent chest CT ≥ 6 months after the start of radiation therapy (radiation therapy group), while 279 patients had a CT scan either prior to or without undergoing radiation therapy (RT). Coronary artery calcium was quantified from CT by applying a threshold-based automated algorithm. Mean age at diagnosis was similar (p = 0.771) between RT (57.4 ± 13.1 years) and NoRT (58.0 ± 11.9 years). Median time between radiation therapy and CT was 2 years. The groups showed no significant differences in race, smoking history, cancer laterality, or cancer stage. 39 (72.2%) of RT patients had a coronary artery calcium score of 0, compared to 201 (72.0%) in patients without radiation therapy. Median coronary artery calcium burden for both groups was not significantly different (p = 0.982), nor when comparing patients who underwent left- versus right-sided radiation therapy (p = 0.453). When adjusting for the time between diagnosis and CT, radiation therapy patients had a significantly lower risk of a positive coronary artery calcium score. In conclusion, breast cancer survivors after radiation therapy are not more likely to show coronary artery calcium on follow-up CT imaging. Our results thus do not support radiation-induced accelerated coronary artery disease as an explanation for higher rates of heart disease in this group.
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Richard A P
RAP
Takx
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Department of Radiology, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, University of Groningen, Groningen, The Netherlands.
Rozemarijn
R
Vliegenthart
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. schoepf@musc.edu.|Division of Cardiology, Department of Medicine, Medical University of South, Carolina, Charleston, SC, USA. schoepf@musc.edu.|Heart and Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, Charleston, SC, 29425-2260, USA. schoepf@musc.edu.
U Joseph
UJ
Schoepf
Department of Biostatistics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Lothar R
LR
Pilz
Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Stefan O
SO
Schoenberg
Division of Cardiology, Department of Medicine, Medical University of South, Carolina, Charleston, SC, USA.
Pamela B
PB
Morris
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Thomas
T
Henzler
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.|Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.|Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Paul
P
Apfaltrer
D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000532:radiotherapy*; D000073116:Cancer Survivors; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000528:radiation effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000209:etiology
Breast neoplasms; Coronary artery disease; Myocardial ischemia; Radiation oncology; Radiation therapy