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  • [Sci Rep.] Heart-related mortality after postoperative breast irradiation in patients with ductal carcinoma in situ in the contemporary radiotherapy era

    [Sci Rep.] Heart-related mortality after postoperative breast irradiation in patients with ductal carcinoma in situ in the contemporary radiotherapy era

    경희의대 / 임유진*

  • 출처
    Sci Rep.
  • 등재일
    2021 Feb 2
  • 저널이슈번호
    11(1):2790. doi: 10.1038/s41598-021-82263-8.
  • 내용

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    Abstract
    Although radiation-induced cardiotoxicity has been addressed, its prognostic relevance to modern radiotherapy (RT) techniques is unclear. This study assessed the impact of adjuvant RT on heart-related deaths in patients with ductal carcinoma in situ. Patients who underwent adjuvant RT after breast-conserving surgery between 1988 and 2008 were identified from the Surveillance, Epidemiology, and End Results database. Kaplan‒Meier and competing risks analyses were conducted after propensity score-matching according to tumor laterality. A total of 41,526 propensity-matched patients were identified (n = 20,763 for either left- or right-sided tumor). In the analysis of the cumulative incidence of heart-related mortality events, there was a greater risk increment in the left-sided group over the first to second decades after RT in patients aged ≤ 50 years (P = 0.048). Competing risks analysis of the young patients showed that left-sided RT was associated with higher heart-related mortality rates (Grey's test, P = 0.049). The statistical significance remained after adjusting for other covariates (subdistribution hazard ratio 2.35; 95% confidence interval 1.09‒5.10). Regarding the intrinsic effect of modern RT techniques, further strategies to reduce heart-related risks are needed for young patients. Close surveillance within an earlier follow-up period should be considered for these patients in clinics.

     

     

     

     

     

     

    Affiliations

    Yu Jin Lim  1 , Jaemoon Koh  2
    1 Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemoon-gu, Seoul, 02447, South Korea. yujindw@gmail.com.
    2 Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

  • 연구소개
    최근의 breast RT 진행이 heart-related mortality에 어떠한 영향을 주는지 알아보기 위해 population-based data를 이용하여 competing risks analysis로 분석했고, 그 결과 50세 이하 젊은 연령의 환자들에서는 breast RT 후 heart-related mortality에 관한 고려가 필요하다고 결론 내렸습니다. DCIS 환자들의 cause of death 분석을 통해 chemotherapy나 targeted agent 사용을 거의 배제하고 RT 자체의 영향을 보았다는 점, 대규모 population 결과라는 점에서 의미가 있지만 database의 특성상 환자 개인별 underlying disease나 dosimetric analysis는 진행하지 못했습니다. 추후에 이러한 정보들을 함께 분석해본다면 임상에 더 많은 도움이 될 것입니다.
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