Cardiovascular Disease Risk in a Large, Population-Based Cohort of Breast Cancer Survivors

Boekel, Naomi B.; Schaapveld, Michael; Gietema, Jourik A.; Russell, Nicola S.; Poortmans, Philip; Theuws, Jacqueline; Schinagl, Dominic A.X.; Rietveld, D.; Versteegh, Michel I.M.; Visser, Otto; Rutgers, Emiel J.; Aleman, Berthe M.P.; Leeuwen, Flora E. van

doi:10.1016/j.ijrobp.2015.11.040

Cited by 97 publications

(87 citation statements)

References 22 publications

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“…The reduction of unintended tissue involvement is more compelling for patients with left-sided breast cancer owing to the unavoidable partial irradiation of the heart. The risk of cardiac toxicity that mainly manifests its effects at a late stage (more than 10 years) was recently well addressed by Darby et al 9 and Boekel et al 10 To mitigate the risk of radiation-induced heart damage, some geometrical precautions can be applied. The most popular is the use of respiratory gating in deep inspiration breath-hold (DIBH), as illustrated by Korreman et al 11,12 and Aznar et al 13 In this case, the distance between the heart and chest wall is increased with the consequent reduction of the heart irradiation.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric trade-offs in breast treatment with VMAT technique

Fogliata

Seppälä

Reggiori

et al. 2017

The British Journal of Radiology

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Objective: Breast planning with volumetric modulated arc therapy (VMAT) has been explored, especially for leftsided breast treatments, with the primary intent of lowering the heart dose and improving target dose homogeneity. As a trade-off, larger healthy tissue volumes would receive low dose levels, with the potential risk of increasing late toxicities and secondary cancer induction, although no clinical data are available today to confirm the risk level. The scope of this work is to explore the dosimetric trade-offs using two different VMAT plans. Methods: Two planning strategies for dual-partial-arc VMAT, RA_avoid and RA_full, with and without avoidance sectors, were explored in a cohort of 20 patients, for whole left breast irradiation for 40.05 Gy to the mean target dose in 15 fractions. Common dose objectives included a stringent dose homogeneity, mean dose to the heart ,5 Gy, ipsilateral lung (I lung ) ,8 Gy, contralateral lung (C lung ) ,2 Gy and contralateral breast (C breast ) ,3 Gy.Results: RA_full showed a better dose conformity, lower high-dose spillage in the healthy tissue and lower skin dose. RA_avoid presented a reduction of the mean doses for all critical structures: 51% to the heart, 12% to the I lung , 81% to the C lung and 73% to the C breast . All differences were significant with p , 0.0001. Conclusion: The adaptation of VMAT options to planning objectives reduced significantly the healthy tissue dose levels at the price of some high-dose spillage. Evaluation of the trade-offs for application to the different critical structures should drive in improving the usage of the VMAT technique for breast cancer treatment. Advances in knowledge: Different planning strategies in the same VMAT technique could give significant variations in dose distributions. The choice of the trade-offs would affect the possible future late toxicity and secondary cancer induction risk. INTRODUCTIONRadiotherapy treatment is an integral part of the standard of care of patients with breast cancer after breast-conserving surgery. Different fractionation schemes have been applied, from the conventional 50 Gy in 25 fractions to hypofractionated regimes like 40.05 Gy delivered in 15 fractions, as proposed by the START (UK Standardisation of Breast Radiotherapy) Trial B.

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Section: Introductionmentioning

confidence: 99%

Dosimetric trade-offs in breast treatment with VMAT technique

Fogliata

Seppälä

Reggiori

et al. 2017

The British Journal of Radiology

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“…Cardiovascular disease risk was often conceptually defined as incidence of cardiovascular diseases including ischemic heart disease, congestive heart failure, myocardial infarction, coronary artery disease, stroke, angina, atrial fibrillation, paroxysmal tachycardia, nonrheumatic valve disease, cardiomyopathy, aortic aneurysm, and arteriosclerosis. [3][4]8,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] While one study included angina as a cardiovascular disease risk factor, 15 Darby et al indicated that angina would not be included as a risk factor due to difficulty with clinical identification of angina. 19 Other investigators conceptually defined cardiovascular disease risk as the presence of cardiovascular disease risk factors including smoking and having an overweight or obese body mass index.…”

Section: Conceptual Definitionsmentioning

confidence: 99%

“…Incidence of cardiovascular diseases using morbidity and mortality was a common measure of cardiovascular disease risk among breast cancer survivors. 4,8,[14][15][16][17][18][19][20][21][22][24][25][26][27]29 Authors of these studies used electronic health records, large databases, and/or linkages to death indexes as data sources. Physical measurements of cardiovascular disease risk are ideal to reduce self-report bias; however, fewer studies conducted physical measurements of cardiovascular disease risk.…”

Section: Operational Definitionmentioning

confidence: 99%

“…16,20 Radiation therapy was associated with increased cardiovascular disease risk. 14,19,22,24 Radiation to the left breast increases radiation exposure to the heart, leading to cardiac ischemia or damage to the coronary arteries. 19 Endocrine therapies including aromatase inhibitors were also associated with an increased cardiovascular disease risk.…”

Section: Cancer Treatmentmentioning

confidence: 99%

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Cardiovascular disease risk among breast cancer survivors: an evolutionary concept analysis

Vo¹,

Nolan²,

Vance³

et al. 2017

NRR

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Background: More than 3.5 million breast cancer survivors are living in the US, and the overall five-year survival rate is approaching 90%. With increased survival and cancer treatment-related cardiotoxicities, there has been a rise in cardiovascular diseases among breast cancer survivors. Yet, cardiovascular disease risk among breast cancer survivors has not been well conceptualized. The purpose of this article was to analyze and define the concept of cardiovascular disease risk among breast cancer survivors. Methods: The databases CINAHL, EMBASE, and PubMed were used to identify articles that explored cardiovascular disease risk among breast cancer survivors. The search yielded 357 articles, which were reviewed for eligibility. Thirty articles were selected based on the inclusion/ exclusion criteria. The concept of cardiovascular disease risk among breast cancer survivors was analyzed using Rodgers' evolutionary concept analysis method. Results: The analysis suggests that cardiovascular disease risk among breast cancer survivors consists of several attributes: cancer treatment (chemotherapy, targeted therapies, radiation therapy, and endocrine therapy), modifiable risk factors (obesity, physical inactivity, poor diet, and smoking), and nonmodifiable risk factors (age, family history, and race). The antecedent identified includes breast cancer diagnosis and the consequence identified includes the development of cardiovascular disease. Conclusion: Findings suggest the need for increased education and understanding of cardiovascular disease risk among health care providers and patients. Survivorship care plans can incorporate cardiovascular disease risk monitoring and screening. Future research is needed to explore interventions and develop stratified screening guidelines for breast cancer survivors.

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“…Рандомизированное исследование, опубликованное датскими коллегами, продемонстрировало отсутствие в показателях радиационно-индуцированной кардиальной смертности после облучения левой МЖ с применением современных технологий ЛТ [5][6][7][8][9].…”

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