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Title: Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes

Abstract

Purpose: The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials: Between 1990 and 1998, 5334 women ≤80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results: The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group hadmore » a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions: There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast cancer treated with HF-WBI or CF-WBI at 15-year follow-up.« less

Authors:
 [1]; ;  [2];  [3];  [4];  [5];  [4];  [4]
  1. Department of Oncology, Saint John Regional Hospital, Saint John (Canada)
  2. Cancer Control Research Department, BC Cancer Agency, Vancouver (Canada)
  3. Division of Cardiology, University of British Columbia, Vancouver (Canada)
  4. Radiation Therapy Program, BC Cancer Agency, Vancouver (Canada)
  5. Breast Cancer Outcomes Unit, BC Cancer Agency, Vancouver (Canada)
Publication Date:
OSTI Identifier:
22416485
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 88; Journal Issue: 4; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEST; COMPARATIVE EVALUATIONS; DISEASE INCIDENCE; HOSPITALS; HYDROFLUORIC ACID; INJURIES; MAMMARY GLANDS; NEOPLASMS; PATIENTS; RADIOTHERAPY

Citation Formats

Chan, Elisa K., Woods, Ryan, McBride, Mary L., Virani, Sean, Nichol, Alan, Speers, Caroline, Wai, Elaine S., and Tyldesley, Scott, E-mail: styldesl@bccancer.bc.ca. Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2013.11.243.
Chan, Elisa K., Woods, Ryan, McBride, Mary L., Virani, Sean, Nichol, Alan, Speers, Caroline, Wai, Elaine S., & Tyldesley, Scott, E-mail: styldesl@bccancer.bc.ca. Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes. United States. doi:10.1016/J.IJROBP.2013.11.243.
Chan, Elisa K., Woods, Ryan, McBride, Mary L., Virani, Sean, Nichol, Alan, Speers, Caroline, Wai, Elaine S., and Tyldesley, Scott, E-mail: styldesl@bccancer.bc.ca. Sat . "Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes". United States. doi:10.1016/J.IJROBP.2013.11.243.
@article{osti_22416485,
title = {Adjuvant Hypofractionated Versus Conventional Whole Breast Radiation Therapy for Early-Stage Breast Cancer: Long-Term Hospital-Related Morbidity From Cardiac Causes},
author = {Chan, Elisa K. and Woods, Ryan and McBride, Mary L. and Virani, Sean and Nichol, Alan and Speers, Caroline and Wai, Elaine S. and Tyldesley, Scott, E-mail: styldesl@bccancer.bc.ca},
abstractNote = {Purpose: The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials: Between 1990 and 1998, 5334 women ≤80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results: The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions: There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast cancer treated with HF-WBI or CF-WBI at 15-year follow-up.},
doi = {10.1016/J.IJROBP.2013.11.243},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 88,
place = {United States},
year = {2014},
month = {3}
}