CARDIOVASCULAR MORTALITY IN A RANDOMIZED TRIAL OF ADJUVANT RADIATION-THERAPY VERSUS SURGERY ALONE IN PRIMARY BREAST-CANCER

被引:334
作者
RUTQVIST, LE
LAX, I
FORNANDER, T
JOHANSSON, H
机构
[1] KAROLINSKA HOSP,RADIUM HEMMET,DEPT HOSP PHYS,S-10401 STOCKHOLM,SWEDEN
[2] KAROLINSKA HOSP,RADIUM HEMMET,DEPT GEN ONCOL,S-10401 STOCKHOLM,SWEDEN
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 1992年 / 22卷 / 05期
关键词
RADIATION THERAPY; BREAST CANCER; MORTALITY; CARDIOVASCULAR DISEASE; LONG-TERM EFFECTS;
D O I
10.1016/0360-3016(92)90784-F
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
One concern with adjuvant radiation therapy for early breast cancer is the potential risk of increasing intercurrent mortality due to radiation-induced damage of the myocardium. The paper presents an analysis of long-term survival among 960 patients with primary breast cancer included in a randomized trial of pre- or postoperative radiation therapy (45 Gy/5 weeks) versus surgery alone. All patients were treated with a modified radical mastectomy. The mean follow-up was 16 years (range: 13-19 years). During the entire follow-up period there was an overall survival difference in favor of the irradiated patients that was of borderline significance (p = 0.09). There was no increase in intercurrent mortality due to any cause. However, when the results were analyzed according to estimated doses of radiation to the myocardium, the subset of patients who received the highest doses, that is, those treated with tangential Co-60 fields for left-sided tumors, were found to have a significantly increased risk of death due to ischemic heart disease compared to the surgical controls (relative hazard: 3.2, p < 0.05). No such increase was observed among the patients who received less radiation to the myocardium, that is, whose chest wall and internal mammary nodes were treated with electrons or those with right-sided tumors, irrespective of the treatment technique. It is concluded that cardiovascular mortality associated with radiation therapy for early breast cancer is correlated with the biological dose of radiation to the heart and the irradiated volume. All of the following factors are thus important: laterality of the tumor, portal arrangements, radiation energy, fractionation, and total dose. The study illustrates that an increased cardiovascular mortality can be avoided by the use of appropriate techniques and avoidance of excessive treatment.
引用
收藏
页码:887 / 896
页数:10
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