Long-term Cardiac Mortality After Hypofractionated Radiation Therapy in Breast Cancer

Abstract

The degree of hypofractionation and parasternal photon beams contributed to increased cardiac mortality in this patient cohort. Differences emerged after 12 to 15 years, indicating the need of more studies with observation time of 2 decades.

Post Mastectomy Adjuvant Radiotherapy in Breast Cancer: A Comparison of Cardiac Toxicity in Hypofractionated and Normal Fractionation Protocols

“…The authors concluded that at least two decades is needed to evaluate safety of such irradiation [13].…”

Impact of Ionizing Radiation on the Cardiovascular System: A Review

“…Tjessem et al investigated hypofractionated radiation therapy in breast cancer patients who received either 10 fractions of 4.3 Gy 32/week (43 Gy total dose) or 20 fractions of 2.5 Gy 35/week (50 Gy total dose). They found patients who received a lower total dose, but higher dose per fraction, had an increased risk of developing fatal ischemic heart disease compared to the group with lower dose fractions (49). This suggested that even if the total dose is lower, a higher dose per fraction was more harmful than a lower dose per fraction with a higher total dose.…”

Radiotherapy of the Lymphatic Pathways in Early Breast Cancer

“…Hypofractionation (HF) is currently not recommended for patients who receive RNI, as larger doses per fraction may increase the risk of long-term effects such as cardiac toxicity or plexopathy [36,37,38]. In the randomized studies investigating HF, 79% of the patients were node negative, only a minority of patients were treated with RNI (Canadian study: none, START A trial: 13%, START B trial: 7% [39,40]).…”