Usefulness of Coronary Computed Tomographic Angiography to Evaluate Coronary Artery Disease in Radiotherapy-Treated Breast Cancer Survivors

Tagami, Travis; Almahariq, Muayad; Balanescu, Dinu Valentin; Quinn, Thomas J.; Dilworth, J.T.; Franklin, Barry A.; Bilolikar, Abhay

doi:10.1016/j.amjcard.2020.12.038

Cited by 9 publications

(16 citation statements)

References 24 publications

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“…On the other hand, the present study consisted of a considerably larger cohort of women than that of Tagami et al. [ 17 ]. In a previous study by our group based partly on the same BC cohort as the present study, radiation dosimetry was studied in 182 women diagnosed with a coronary stenosis subsequent to RT.…”

Section: Discussionmentioning

confidence: 84%

“…There are some recently published studies reporting coronary events after RT, registered by coronary angiography or coronary computed tomography angiography (CCTA) [ 9 , 15 , 17 ]. In a study by Tagami et al.…”

Section: Discussionmentioning

confidence: 99%

“…In a study by Tagami et al. [ 17 ], 94 patients treated with RT and subsequently diagnosed with coronary stenosis on CCTA were identified. In women treated with left-sided RT, a statistically significantly increased risk of coronary disease was seen in the LAD and the mean LAD radiation dose correlated with the risk of coronary disease.…”

Section: Discussionmentioning

confidence: 99%

“…In women treated with left-sided RT, a statistically significantly increased risk of coronary disease was seen in the LAD and the mean LAD radiation dose correlated with the risk of coronary disease. Based on these results, the authors suggested that ∼3 Gy may be a reasonable constraint for LAD doses at RT planning [ 17 ]. Since individual radiation doses were not available in the present study, we could not estimate risk of coronary stenosis per Gy.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies in more recently treated patients show conflicting results, and since RT-induced IHD is generally considered to be a late event, the follow-up may be too short draw firm conclusions [ 9 – 12 ]. A higher incidence of coronary stenosis in the left anterior descending artery (LAD) has been reported after RT of left-sided compared to right-sided BC, and some studies show a relationship between LAD radiation dose and the risk of developing coronary stenosis [ 13 – 17 ]. Increasing awareness of long-term cardiac toxicity and the development of new radiation techniques have contributed to reduced cardiac radiation dose exposure over recent decades.…”

Section: Introductionmentioning

confidence: 99%

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Risk of coronary stenosis after adjuvant radiotherapy for breast cancer

et al. 2022

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Purpose Adjuvant radiotherapy (RT) for breast cancer is associated with an increased risk of ischemic heart disease. We examined the risk of coronary artery stenosis in a large cohort of women with breast cancer receiving adjuvant RT. Methods A cohort of women diagnosed with breast cancer between 1992 and 2012 in three Swedish health care regions (n = 57,066) were linked to the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) to identify women receiving RT who subsequently underwent a percutaneous coronary intervention (PCI) due to coronary stenosis. Cox regression analyses were performed to examine risk of a coronary intervention and competing risk analyses were performed to calculate cumulative incidence. Results A total of 649 women with left-sided breast cancer and 494 women with right-sided breast cancer underwent a PCI. Women who received left-sided RT had a significantly higher risk of a PCI in the left anterior descending artery (LAD) compared to women who received right-sided RT, hazard ratio (HR) 1.44 (95% confidence interval [CI] 1.21–1.77, p < 0.001). For the proximal, mid, and distal LAD, the HRs were 1.60 (95% CI 1.22–2.10), 1.38 (95% CI 1.07–1.78), and 2.43 (95% CI 1.33–4.41), respectively. The cumulative incidence of coronary events at 25 years from breast cancer diagnosis were 7.0% in women receiving left-sided RT and 4.4% in women receiving right-sided RT. Conclusion Implementing and further developing techniques that lower cardiac doses is important in order to reduce the risk of long-term side effects of adjuvant RT for breast cancer.

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Section: Discussionmentioning

confidence: 84%