The association between the radiation field including the heart of breast cancer radiotherapy and the occurrence of coronary artery disease in patients
10.3760/cma.j.cn113030-20250123-00037
- VernacularTitle:乳腺癌放射治疗照射野累及心脏与患者发生冠心病的关系
- Author:
Wenhui CAI
1
;
Wenduo ZHANG
;
Hongfei LI
;
Qinhong WU
;
Mingyuan ZHU
;
Hailei LIN
;
Huimin LI
;
Yuzhu LU
;
Qiuzi ZHONG
;
Xue YU
Author Information
1. 中国医学科学院/北京协和医学院，北京 100005
- Publication Type:Journal Article
- Keywords:
Breast neoplasms;
Radiotherapy;
Radiation-induced heart disease
- From:
Chinese Journal of Radiation Oncology
2025;34(7):677-683
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate whether there is an association between the total dose of breast cancer radiotherapy, the mean dose of radiation field involving the heart and its substructures, and the long-term incidence of coronary heart disease (CHD) in patients.Methods:A retrospective analysis was conducted on 1125 patients with breast cancer who received radiotherapy with radiation fields involving the hear at Beijing Hospital from January 2009 to June 2022. The heart and its substructures of 54 patients were manually delineated, trained an automatic delineation model, and applied this model to the original radiotherapy planning images to automatically extract dosimetric parameters for the heart and substructures in the original plan. Based on the follow-up results, 1125 breast cancer patients were categorized into the CHD event group ( n=19) and non-event group ( n=1106). Wilcoxon rank-sum test, Chi-square test and adjustment for confounding factors using inverse probability weighting were used to compare the mean radiation dose received by the heart and its substructures, age at presentation, history of smoking, history of alcohol consumption, history of hypertension, and history of diabetes between two groups. The influencing factors of CHD were analyzed by univariate and multivariate logistic regression models. Results:The mean heart dose ( P=0.035), mean dose of right atrium ( P=0.049), right coronary artery ( P=0.013), septum ( P=0.045), and right ventricle ( P=0.039) of the event group were higher than that of the non-event group, and the differences were statistically significant. History of alcohol consumption was an independent risk factor for long-term CHD events in the breast cancer patients ( OR=7.35,95% CI: 1.56-25.58, P=0.004). After adjusting for confounding factors using inverse probability weighting, age at presentation was an independent risk factor for long-term CHD events ( OR=1.03, 95% CI: 1.01-1.05, P=0.004). Conclusions:In the breast cancer population with traditional high-risk factors of CHD receiving radiotherapy, the possibility of CHD probably remains high even if the dose of radiation field involving the heart and its substructures is low. Compared to traditional risk factors of CHD, the mean dose to the heart and its substructures in the radiation field of breast cancer patients exerts less impact on the occurrence of CHD after radiotherapy.
