[ad_1]
Breast cancer survivors treated with older radiation protocols continued to present a significant risk of treatment-related cardiovascular disease for decades, concluded the authors of an extensive retrospective review.
the review showed that chemotherapy containing anthracyclines badociated with irradiation of the internal bad chain (MIC) was badociated with a risk of heart failure (CHF) nine times that of women in the general population. According to Flora E. van Leeuwen, Ph.D. of the Netherlands Cancer Institute of Amsterdam, and colleagues, treatment with anthracycline alone increases the risk of heart failure four times more than the general population
BMI irradiation also increases the risk of ischemic heart disease. (IHD) and Valvular Heart Disease (VHD), regardless of whether radiotherapy was on the right or left side. In many cases, the risk of cardiovascular disease has not emerged for 20 years or more after bad cancer treatment, they reported in the British Journal of Cancer . "Our findings are relevant for a large number of bad cancer survivors treated with older BMI regimens, who may remain at a high risk of CVD for a long time," the authors said. "The follow-up in our study was too short to detect or reject an IHD-badociated risk increase badociated with BMI irradiation between 2000 and 2009."
"Recent studies showing an improvement in bad cancer survival rates after BMI irradiation still do not have enough follow-up." An independent study showed a dose-dependent combination of irradiation for bad cancer and the risk of left ventricular lesion, "they noted
. (LV) and segments of the coronary artery.Covering a 43-year period beginning in 1958, the data suggests that all coronary segments "are radiation-sensitive and that doses at all segments must be minimized," Carolyn Taylor, PhD, of Oxford University in England and colleagues in the Journal of Clinical Oncology
Better Survival, New Risks
Advances in the early diagnosis and treatment of bad cancer have dramatically improved survival in recent decades. Treatment and anthracycline-based chemotherapy have helped improve survival but at a recognized cost of increased risk of cardiovascular disease, noted Van Leeuwen's group.
Anthracycline-based chemotherapy depends on cardiomyopathy and heart failure. the incidence varied in previous studies. Documented cardiac effects of radiotherapy include ischemic heart disease and viral haemorrhagic disease, and some studies suggest that effects are dose dependent.
Initial studies suggest that adverse cardiac effects of radiotherapy appeared about 10 years after exposure. the risk begins to increase in the 5 years of exposure, the authors continued.
Given the growing population of bad cancer survivors, researchers sought to quantify the long-term risks of CVD after treatment of the disease. The badysis included 14,645 Dutch patients aged less than 62 years, treated for early bad cancer between 1970 and 2009, followed by 2012.
After surgery, 56% of patients received radiotherapy alone, 3 % received chemotherapy alone, 30% received both and 11% received none. For patients who received radiation at the bad or at the chest wall but not at BMI, the usual radiation dose in the heart ranged between 4 and 6 Gy between 2000 and 2009, when it decreased at about 1.5 Gy.
BMI, the typical heart dose ranged from 12 to 22 Gy, with the exception of the subgroup of women who received radiation at the same time. BMI and bad, which was badociated with a cardiac dose of 9 Gy between 2000 and 2009.
BMI was not exposed, the ratio of CVD (RR) rate for l 39; irradiation of left-sided animals against rights was 1.11, which did not yield statistical significance (95% CI: 0.93-1.32). Brain irradiation at a dose of 9 to 16 Gy compared to right bad irradiation did significantly increase the risk of total CVD, IHD, VHD and CHF (RR 1.6-). 2.4). Anthracycline-based chemotherapy significantly increased the risk of CHF compared to the general Dutch population of women in the 5 years of treatment and remained high at least 10 to 15 years after treatment (HR 4 , 18, 95% CI 3.07-5.69). The combination of BMI irradiation and anthracycline-based chemotherapy increased the risk of CHF more than nine-fold compared with women exposed to any treatment (HR 9.23, 95% CI 6.01). -14,18)
The study had some limitations, including the possibility of undeclared CVD.
Higher doses of RT, a higher risk
Taylor's group badyzed the badociation between radiotherapy and the risk of CVD in 456 women who received radiotherapy for bad cancer from 1958 to 2001. events. The five-segment LV radiation dose could be estimated for 414 patients. In addition, the six-segment coronary radiation dose was estimated for a subset of 133 patients with documented coronary artery disease ≥70 stenosis.
Of the 414 patients with LV, 243 had left bad cancer and 171 had cancer. The authors noted that the unilateral cancer (RR 1.42, 95% CI 1.17-1.73) reflected a dose of higher LV radiation in cancer on the left side.
For the five segments evaluated, the left-right-side ratios of radiotherapy was 0.94 for inferiority (95% CI 0.70-1.25); 1.42 for lateral (95% CI 1.04-1.95); 2.09 for the septum (95% CI 1.37-3.19); 1.85 for the anterior (95% CI 1.39-2.46); and 4.64 for the apex (95% CI 2.42-8.90). The corresponding radiation dose differences for the five segments were 2.7, 4.9, 7.2, 10.4 and 21.6 Gy ( P <0.001 for trend).
For the subgroup of women with coronary artery disease, the left-right radiotherapy for the six segments evaluated was 0.48 for the proximal right coronary artery (95% CI 0.26-0, 91); 1.69 for middle / distal right coronary (95% CI 0.85-3.36); 1.46 for proximal circumflex (95% CI 0.72-2.96); 1.11 for the distal circumflex (95% CI 0.45-2.73); 1.89 for proximal left anterior descent (95% CI 1.07-3.34); and 2.33 for the mean / distal left anterior descent (95% CI 1.19-4.59). The corresponding left-minus-right radiation dose differences were -5.0, -2.5, 1.6, 3.5, 9.5 and 38.8 Gy ( P = 0.002 for the trend).
"For individual LV and coronary artery segments, higher radiation doses were strongly badociated with more frequent injuries, suggesting that all segments are radiation sensitive and that doses to all segments should be minimized, "conclude the authors
. was unavailable because women were irradiated prior to the planning era of three-dimensional radiotherapy by CT scan.Therefore, it was necessary to estimate cardiac doses retrospectively using a typical scanner. "
The study by Van Leeuwen's group was supported by the Society, Cancer Research UK, the Center for Excellence in Research of the British Heart Foundation, Oxford, the Medical Research Council of the United Kingdom, and the British Heart Foundation at the Unit of Clinical Trials Department of Oxford University.
n Leeuwen and his coauthors did not reveal any relevant relationship with the industry.
The Taylor group study was supported by Cancer Research UK, the University of Oxford as part of the Department of Health Policy Research, the UK Medical Research Council, the British Heart Foundation at the University of Oxford's Clinical Trials Service Unit and at the British Heart Foundation's Center for Research Excellence at the University of Oxford
Taylor has not revealed any relevant relationship with the industry. One or more co-authors have described relevant relationships with AstraZeneca, Atossa Genetics and Celgene.
2018-07-31T19: 00: 00-0400
Source link
