No long-term increase in cardiac-related mortality after breast-conserving surgery and radiation therapy using modern techniques.

Nixon, Asa J.; Manola, Judi; Gelman, Rebecca; Bornstein, Bruce A.; Abner, Anthony; Hetelekidis, Stella; Recht, Abram; Harris, Jay R.

doi:10.1200/jco.1998.16.4.1374

Cited by 160 publications

(60 citation statements)

References 16 publications

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“…[21][22][23][24] However, the published literature concerning late cardiopulmonary mortality in patients with esophageal cancer who are treated with RT is scarce. Morota et al investigated 74 patients who were treated with definitive concurrent CRT using an extended field from the supraclavicular fossa to the gastroesophageal junction, and concluded that the risk of grade 3 or greater cardiopulmonary toxicities was greater in patients aged > 75 years (29% vs 3%).…”

Section: Discussionmentioning

confidence: 99%

The impact of radiation therapy sequencing on survival and cardiopulmonary mortality in the combined modality treatment of patients with esophageal cancer

Wojcieszynski

Berman²,

Wan³

et al. 2013

Cancer

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BACKGROUND: The addition of chemoradiation (CRT) to surgery has been shown to improve survival in patients with esophageal cancer. In the current study, the authors determined whether the sequencing of CRT has an effect on survival and cardiopulmonary mortality in patients with esophageal cancer. METHODS: Patients with the following inclusion criteria were identified within 17 Surveillance, Epidemiology, and End Results registries from 1988 through 2007: adenocarcinoma or squamous cell carcinoma of the esophagus and having undergone esophagectomy. Patients who died within 90 days of surgery were excluded. Demographic, tumor, and survival data were compared between patients receiving preoperative and postoperative RT. Cox proportional hazards regression models were calculated to identify parameters associated with cause-specific survival and overall survival. A competing risk analysis was performed to account for death due to esophageal cancer in the calculation of cardiopulmonary mortality. RESULTS: Of 5512 patients, 1881 received preoperative RT, 901 received postoperative RT, and 2730 did not receive RT. Patients receiving preoperative RT had improved 5-year cause-specific survival (41% vs 31%; P < .0001) and overall survival (33% vs 23%; P < .0001) compared with those receiving postoperative RT. No differences in adjusted cardiopulmonary mortality were found between patients who received RT versus those who did not (8% vs 10% at 10 years; hazards ratio [HR] KEYWORDS: esophageal neoplasms, combined modality therapy, radiation oncology, survival, heart diseases, lung diseases. INTRODUCTIONIn patients with locally advanced esophageal cancer, the addition of chemoradiation (CRT) to surgery has shown improvements in overall survival (OS) when given preoperatively. [1][2][3][4][5][6] In the subset of patients with tumors of the gastroesophageal junction, CRT delivered postoperatively has also demonstrated a survival benefit. 7 To the best of our knowledge, no randomized controlled trials currently exist that compare the outcomes of the sequencing of CRT in relation to surgery in patients with esophageal cancer.Preoperative CRT is preferred over postoperative treatment in patients with other gastrointestinal malignancies such as rectal cancer, in whom preoperative CRT has been demonstrated to have a superior locoregional control rate, toxicity profile, and survival rate. 8,9 It is postulated that preoperative treatment is favored because of tumor downstaging and smaller radiation treatment fields. We hypothesized that preoperative RT is associated with decreased cardiopulmonary mortality from lower RT doses to the heart and lungs as well as improved survival outcomes compared with postoperative RT in patients with esophageal cancer.Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, we assessed differences in survival outcomes between patients treated with preoperative RT and those treated with postoperative RT and analyzed the effect of RT on heart and lung morbidity a...

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Section: Discussionmentioning

confidence: 99%

The impact of radiation therapy sequencing on survival and cardiopulmonary mortality in the combined modality treatment of patients with esophageal cancer

Wojcieszynski

Berman²,

Wan³

et al. 2013

Cancer

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“…Patients lay in flat position with the ipsilateral arm flexed tightly under the neck. The median number of CT slices was 23 (range [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The target volume and the risk organs (lung and heart including the basis of the aorta) were delineated in every CT slice and the dose planning was carried out using the 3-D-planning system Helax TMS.…”

Section: Methodsmentioning

confidence: 99%

Radiotherapy of Internal Mammary Lymph Nodes in Breast Cancer

Sautter-Bihl

Hültenschmidt

Melcher

et al. 2002

Strahlentherapie und Onkologie

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“…In addition, the meta-analysis of 40 randomized trials of radiotherapy involving 20,000 breast cancer patients by the Early Breast Cancer Trialists' Collaborative Group demonstrated that the addition of radiotherapy decreased cancer specific mortality, but that non-cancer mortality increased [50]. Three series from single institutions applying modern radiotherapy techniques did not find an increase in myocardial infarction [51] or cardiac-related mortality after 9-12 years of follow-up [52,53]. Nevertheless, radiotherapy causes volumedependent perfusion defects of the heart in up to 40% of patients within 2 years of treatment, leading to wall motion abnormalities [54].…”

Section: Referencesmentioning

confidence: 99%

Late Toxicity of Radiotherapy: A Problem or a Challenge for the Radiation Oncologist?

Petersen

Würschmidt²

2011

Breast Care

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Background: Large randomized clinical trials have established radiotherapy in conjunction with adjuvant systemic treatment as standard treatment in breast cancer after both mastectomy and lumpectomy. Although standard radiation therapy is well tolerated by the majority of patients, some patients might suffer from late normal tissue effects. Methods: The literature on radiotherapy following surgery of breast cancer was reviewed with regard to late toxicity. Results: Radiotherapy may, to some degree, cause persistent pain in the breast, arm and shoulder in up to 30–50% of patients after 3–5 years, lymphedema in 15–25%, and restriction of arm and shoulder movement in 35%. Awareness of cardiotoxicity is needed since anthracyclines, trastuzumab, and radiotherapy may cause damage to the heart. However, using modern radiotherapy techniques, the available evidence does not suggest a higher incidence of cardiac mortality. Conclusions: This review updates the database on toxicity from radiation in breast cancer. Advances in research of radiation-induced late effects may lead to improved treatment choices for breast cancer patients including radiotherapy and may improve quality of life after surviving breast cancer.

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No long-term increase in cardiac-related mortality after breast-conserving surgery and radiation therapy using modern techniques.

Abstract: These results suggest that modern breast radiotherapy is not associated with an increased risk of cardiac-related mortality within at least the first 12 years after treatment.

Cited by 160 publications

References 16 publications

The impact of radiation therapy sequencing on survival and cardiopulmonary mortality in the combined modality treatment of patients with esophageal cancer

The impact of radiation therapy sequencing on survival and cardiopulmonary mortality in the combined modality treatment of patients with esophageal cancer

Radiotherapy of Internal Mammary Lymph Nodes in Breast Cancer

Late Toxicity of Radiotherapy: A Problem or a Challenge for the Radiation Oncologist?

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