Mortality patterns over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy

Jones, Judy; Ribeiro, G

doi:10.1016/s0009-9260(89)80099-6

Cited by 147 publications

(40 citation statements)

References 10 publications

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“…Moreover, the myocardium receives some radiation also in patients treated for right-sided tumours but the clinical significance of such relatively small doses remains controversial. In the Manchester trials no significant excess risk of cardiac death was observed with radiation in patients with right-sided tumours (Jones & Ribeiro, 1988) whereas in the mentioned CRC trial the risk appeared to be slightly increased after 5 years (RR: 1.20 …”

Section: Resultsmentioning

confidence: 90%

“…Analyses of cause-specific mortality in individual radiotherapy studies have indicated that this observation may have been due to an increase of cardiovascular deaths as a result of radiationinduced damage to the myocardium (Host et al, 1986;Haybittle et al, 1988;Jones & Ribeiro, 1988). This paper presents data on intercurrent mortality by laterality of the primary tumour among breast cancer patients reported to the Swedish Cancer Registry during [1970][1971][1972][1973][1974][1975][1976][1977][1978][1979][1980][1981][1982][1983][1984][1985] Log rank comparisons were made of time from diagnosis of breast cancer to the mentioned end-points by laterality of the tumour (Peto et al, 1976(Peto et al, , 1977.…”

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confidence: 99%

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Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish Cancer Registry

Rutqvist

Johansson²

1990

Br J Cancer

229

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Summary To examine the hypothesis that radiotherapy for breast cancer can cause myocardial infarction, cause-specific mortality by laterality of the primary tumour was analysed among 54,617 breast cancer patients reported to the Swedish Cancer Registry during [1970][1971][1972][1973][1974][1975][1976][1977][1978][1979][1980][1981][1982][1983][1984][1985]. The rationale was that radiotherapy for a left-sided breast cancer invariably results in higher doses of radiation to the myocardium than a similar treatment given for a right-sided tumour whereas other possible risk factors for cardiovascular disease probably are unrelated to the laterality of the tumour. The median follow-up was 9 years (range 1-17 years). Patients with left-sided tumours were found to have a higher mortality due to myocardial infarction than patients with right-sided tumours (P<0.01) but there was no difference in regard to total intercurrent mortality. Further analyses of individual radiotherapy studies are warranted to quantify the excess risk associated with radiation and to study the significance of the type of radiation, portal arrangements, total dose and fractionation. It seems reasonable to assume that adverse effects of radiation are dose-related and may thus be minimised or prevented by the use of appropriate treatment techniques.

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Section: Resultsmentioning

confidence: 90%

mentioning

confidence: 99%

Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish Cancer Registry

Rutqvist

Johansson²

1990

Br J Cancer

229

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“…tients dying from a late excess of cardiac disease. This fact has been demonstrated in other individual trials [9][10][11], by a review of registry data [ 12], and in the latest overview of trials [ 13]. The significance of these results to modern management of early breast cancer is not clear.…”

Section: Discussionmentioning

confidence: 95%

Role of radiotherapy following total mastectomy in patients with early breast cancer

Houghton

Baum²,

Haybittle³

1994

World j. surg.

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Between June 1970 and April 1975 the CRC (King's/Cambridge) Trial for early breast cancer randomized 2800 patients following mastectomy to immediate prophylactic radiotherapy (DXT group, n = 1376) or control (WP group, n = 1424). Although no difference in overall survival has been demonstrated, there is an increase in mortality in the irradiated patients from nonbreast cancer causes beyond 5 years. It is because of an increase in the number of deaths due to new nonbreast malignancies [RR V 1.89 (1.18-3.05)] and to cardiac-related disease [RR = 1.52 (1.01-2.29)]. This increased cardiac death rate may be related to the use of orthovoltage, which has greater scatter. There was a significant increase in risk for those with left-sided rather than right-sided tumors in this subgroup [chi 2 (int) = 5.08; p = 0.02]. Local relapse was significantly reduced in those patients randomized to radiotherapy [RR = 0.44 (0.39-0.51)]. Median survival following local relapse was 1.35 years in the DXT group and 2.66 years in the WP group (logrank p < 0.001). Patients with the first relapse in the supraclavicular nodes had a particularly poor prognosis (median survival: DXT 0.69 years; WP 1.37 years). Almost 50% of patients who have had a recurrence on the chest wall or in the axilla and subsequently died have had disease at the same site at death, regardless of whether they had radiotherapy immediately following surgery. However, the actual number of patients dying with persistent disease is halved by the use of prophylactic radiotherapy (DXT 66; WP 143). Classic pathological features such as tumor size, tumor grade, and nodal involvement help define those patients at high risk of local failure who should be recommended for immediate radiotherapy.

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“…In some analyses, this resulted in an increased overall mortality in subgroups of patients. particularly those with left-side tumors which, for anatomical reasons, received higher doses to the heart than patients with right-side tumors (7)(8)(9)(64)(65)(66). Studies using modern radiotherapy technology that avoids excessive irradiation dosage have, as mentioned previously, demonstrated a significant reduction in distant metastases and reduced mortality rates from breast cancer (4,5 -that available data from meta-analyses suggest that radiotherapy based on modern technology can reduce the risk of death from the disease (4, 5).…”

Section: Survival; Relapse-free and Totalmentioning

confidence: 99%

“…Radiotherapy for breast cancer can lead to acute and/or late side effects in nearby organs a t risk, eg, the heart, lungs, and brachial plexus (9,64,66,(76)(77)(78). As mentioned above, earlier studies have shown that excessive radiation doses to the heart led to increased cardiovascular mortality in treated patients, particularly those with leftside tumors (7)(8)(9).…”

Section: Side Effectsmentioning

confidence: 99%

Breast Cancer

Rutqvist¹

1996

Acta Oncologica

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Mortality patterns over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy

Cited by 147 publications

References 10 publications

Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish Cancer Registry

Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish Cancer Registry

Role of radiotherapy following total mastectomy in patients with early breast cancer

Breast Cancer

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