Coronary Calcium Scanning in Patients after Adjuvant Radiation for Early Breast Cancer and Ductal Carcinoma In situ

Abstract

Background and Objective: Radiation therapy (RT) is part of standard adjuvant treatment for breast cancer. Earlier studies demonstrated increased cardiac morbidity and mortality from this. Coronary Calcium scanning utilizing Multidetector Computed Tomography (MDCT) can detect early atherosclerosis in coronary arteries by identifying the amount of calcifications. In our study we employed these tools to detect occult atherosclerosis at least 5 years following breast RT.Methods: We evaluated 20 asymptomatic patients, <60 years old, treated with RT at least 5 years prior to enrollment. Nine received RT to the left and 11 to the right chest wall. The median interval between RT and calcium scan was 8 years. All patients were treated with external beam RT using tangential technique. All patients underwent MDCT to compute volumetric and Agatston calcium scores of the coronary arteries and the aorta.Results: Eleven patients had RT to the right chest wall, and eight had a calcium score of 0, while two had minimally elevated scores and one patient had a significantly elevated score. Meanwhile nine patients had RT to the left chest wall, and seven had a calcium score of 0. None had significantly elevated scores. In the aorta, 11 of 20 patients had a score of 0, while 8 of 20 had minimally elevated scores.Conclusion: In contrast to studies demonstrating increased cardiovascular morbidity, our pilot study did not detect significant occult atherosclerosis using MDCT of the coronaries and aorta of patients assessed five or more years following radiation for treatment of breast cancer.

Coronary calcium score in 12-year breast cancer survivors after adjuvant radiotherapy with low to moderate heart exposure – Relationship to cardiac radiation dose and cardiovascular risk factors

“…Chang et al evaluated CAC scores in 20 irradiated BC patients with a median observation time of 8 years [10]. They found no increase in coronary calcium burden in these patients, and there was no difference between right and left-sided BC patients.…”

“…The breast/chest wall received a total dose of 50 Gy given in 25 fractions over five weeks. After breast conserving surgery, women below the age of 50 received an electron boost of 10-16 Gy to the tumour bed (6)(7)(8)(9)(10)(11)(12). After mastectomy, all stage III patients and women with stage II with positive resection margins were given a bolus covering the chest wall, the remaining patients received a bolus covering the mastectomy scar with a 3 cm margin.…”

Coronary Artery Calcium Score Assessment in Breast Cancer Patients After Three-Dimensional Conformal Radiotherapy: Is Calcium Score an Appropriate Screening Study?

“…The total coronary AS was equal to 428.16. To the best of our knowledge, there are two previous studies evaluating CACS burden after thoracic RT for BC patients (33,34). Chang et al studied BC patients who were treated using the conventional 2D-RT technique (33,34).…”

“…To the best of our knowledge, there are two previous studies evaluating CACS burden after thoracic RT for BC patients (33,34). Chang et al studied BC patients who were treated using the conventional 2D-RT technique (33,34). Some of the patients in Tjessem et al study received radiation by the currently standard 3D-CRT technique; while, their other patients had undergone older 2D-RT (34).…”

Early detection of cardiovascular changes after radiotherapy for breast cancer: Protocol for a European multicenter prospective cohort (MEDIRAD EARLY HEART Study) (Preprint)

“…Three studies have measured the amount of CAC in the years following RT treatment for BC. In two studies, no elevated CAC scores in BC patients were found 5 to 15.7 years after RT treatment, whereas one study did find an increase in CAC score depending on radiation dose to the heart [21][22][23]. Among the studies that did not find a CAC score increase, one did not include baseline CAC scores and the other only included a relatively small number of patients, which makes it difficult to draw definitive conclusions from these two studies.…”