Long-term complication of the thoracic radiation in breast cancer: An complete atrioventricular block case

Messina, Francesco; Romano, Pietro; Paino, Mario; Crosca, Sergio

doi:10.1016/j.ijcard.2015.08.149

Cited by 4 publications

(4 citation statements)

References 14 publications

(14 reference statements)

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“…Among cardiac complications of thoracic RT, arrhythmia and conduction disorders are much less frequent than coronary artery disease [approximately 4%-5% (9)] and investigations on these complications were limited. Several case reports suggested a link between RT for BC and atrioventricular nodal bradycardia, and all levels of heart block, including complete heart block and sick sinus syndrome (10)(11)(12). Some cohort studies have shown that BC patients treated with RT had a higher risk of morbidity and mortality of cardiac arrhythmia than BC patients not treated with RT (13,14).…”

Section: Introductionmentioning

confidence: 99%

Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study

et al. 2022

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BackgroundPrevious studies suggested that radiation therapy (RT) for breast cancer (BC) can induce cardiac arrhythmias and conduction disorders. However, the association with mean heart dose and specific cardiac substructures doses was less studied.Materials and MethodsWe conducted a nested case–control study based on French BC patients, enrolled in the European MEDIRAD-BRACE study (https://clinicaltrials.gov, Identifier: NCT03211442), who underwent three-dimensional conformal radiation therapy (3D-CRT) between 2009 and 2013 and were retrospectively followed until 2019. Cases were incident cases of cardiac arrhythmia. Controls without arrhythmia were selected with propensity-scored matching by age, duration of follow-up, chemotherapy, hypertension, and diabetes (ratio 1:4 or 5). Doses to the whole heart (WH), left and right atria (LA and RA), and left and right ventricles (LV and RV) were obtained after delineation with multi-atlas-based automatic segmentation.ResultsThe study included 116 patients (21 cases and 95 controls). Mean age at RT was 64 ± 10 years, mean follow-up was 7.0 ± 1.3 years, and mean interval from RT to arrhythmia was 4.3 ± 2.1 years. None of the results on association between arrhythmia and cardiac doses reached statistical significance. However, the proportion of right-sided BC was higher among patients with arrhythmia than among controls (57% vs. 51%, OR = 1.18, p = 0.73). Neither mean WH dose, nor LV, RV, and LA doses were associated with an increased risk of arrhythmia (OR = 1.00, p > 0.90). In contrast, the RA dose was slightly higher for cases compared to controls [interquartile range (0.61–1.46 Gy) vs. (0.49–1.31 Gy), p = 0.44], and a non-significant trend toward a potentially higher risk of arrhythmia with increasing RA dose was observed (OR = 1.19, p = 0.60). Subanalysis according to BC laterality showed that the association with RA dose was reinforced specifically for left-sided BC (OR = 1.76, p = 0.75), while for right-sided BC, the ratio of mean RA/WH doses may better predict arrhythmia (OR = 2.39, p = 0.35).ConclusionDespite non-significant results, our exploratory investigation on BC patients treated with RT is the first study to suggest that right-sided BC patients and the right atrium irradiation may require special attention regarding the risk of cardiac arrhythmia and conduction disorders. Further studies are needed to expand on this topic.

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Section: Introductionmentioning

confidence: 99%

Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study

et al. 2022

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“…However, the tissue fibrosis induced by RT could be responsible for secondary non-specific atrial, ventricular and coronary cardiac lesions which are the pathophysiological bed of arrhythmias or conduction disorders. Some case reports suggested a link between BC RT and atrioventricular block, a severe form of conduction system disorder for which permanent pacing is the therapy of choice [4] , [5] . Some cohort studies have shown that BC patients treated with RT had a higher risk of cardiac rhythm disorder or mortality for conductive disorders than BC patients not treated with RT [6] , [7] , but this higher risk was not observed in a study on arrhythmia and conduction disorders requiring of pacemaker or defibrillator implantations [8] .…”

Section: Introductionmentioning

confidence: 99%

Risk of pacemaker implantation after radiotherapy for breast cancer: A study based on French nationwide health care database sample

Errahmani

Thariat²,

Ferrières

et al. 2022

IJC Heart & Vasculature

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Background Among cardiac complications of breast cancer radiotherapy (BC RT), there are very limited data on arrhythmia and conduction disorders, in particular severe cases requiring permanent pacemaker implantation (PPMI). Therefore, this exploratory study aimed to evaluate the risk of PPMI for BC patients treated with RT, compared with the general population and with BC patients not treated with RT. Methods The study was performed on a 1/97 representative sample of the French health care database (EGB database). Adult women with a first BC treated with or without RT between 2008 and 2016 were included, followed until 2018, and de novo PPMI were identified. We compared the PPMI incidence in BC cohort relative to the general population with standardized incidence ratio (SIR) and evaluated the risk of PPMI in RT patients compared to patients without RT with a competing risk survival analysis. Results A total of 3853 BCE patients were included. Among BC patients treated with RT, 28 PPMI cases were observed compared with 13 expected cases, corresponding to a SIR of 2.18 [95% CI: 1.45–3.06]. For BC patients not treated with RT, the SIR was 1.01 [95% CI: 0.40–1.90]. Patients treated with RT showed a borderline significant higher risk of PPMI compared with those not treated with RT (subdistribution Hazard Ratio = 2.08, 95% CI 0.87–4.97, p = 0.09). Conclusions Our exploratory findings indicate that, over the last decade in France, BC patients treated with RT appeared to be at higher risk of PPMI than general population. Further studies are needed to expand on this topic.

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“…But these arrhythmias and conduction disorders could also potentially be due to direct damage to critical cardiac structures, such as the sino-atrial node and the atrioventricular node. Several cases reports suggested that radiation was associated prolonged QT interval, ventricular tachycardia, sinus node dysfunction, atrioventricular blocks, and bundle branch blocks [7] , [8] , [9] , [10] , but also in several cohort studies. Patients receiving RT for BC had a higher risk of cardiac arrhythmia and conduction disorders morbidity and mortality compared to those without RT [11] , [12] .…”

Section: Introductionmentioning

confidence: 99%

Supraventricular cardiac conduction system exposure in breast cancer patients treated with radiotherapy and association with heart and cardiac chambers doses

Errahmani¹,

Locquet²,

Broggio³

et al. 2023

Clinical and Translational Radiation Oncology

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Long-term complication of the thoracic radiation in breast cancer: An complete atrioventricular block case

Cited by 4 publications

References 14 publications

Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study

Association Between Cardiac Radiation Exposure and the Risk of Arrhythmia in Breast Cancer Patients Treated With Radiotherapy: A Case–Control Study

Risk of pacemaker implantation after radiotherapy for breast cancer: A study based on French nationwide health care database sample

Supraventricular cardiac conduction system exposure in breast cancer patients treated with radiotherapy and association with heart and cardiac chambers doses

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