ABSTRACT

BACKGROUND: Previous studies focused on the impact of cardiovascular diseases (CVD) risk factors in breast cancer patients with chemotherapy (CT) or radiotherapy (RT). This study aimed to identify the impact of tumor characteristics on CVD death in these patients.

METHODS: Data of female breast cancer patients with CT or RT between 2004 and 2016 were included. The risk factors of CVD death were identified using Cox regression analyses. A nomogram was constructed to evaluate the predicted value of tumor characteristics, and then validated by the concordance indexes (C-index) and calibration curves.

RESULT: A total of 28,539 patients were included with an average follow-up of 6.1 years. Tumor size > 45 mm (adjusted HR = 1.431, 95% CI = 1.116-1.836, P= 0.005), regional (adjusted HR = 1.278, 95% CI = 1.048-1.560, P= 0.015) and distant stage (adjusted HR = 2.240, 95% CI = 1.444-3.474, P< 0.001) were risk factors of CVD death for breast cancer patients with CT or RT. The prediction nomogram of tumor characteristics (tumor size and stage) on CVD survival was established. The C-index of internal and external validation were 0.780 (95% Cl = 0.751-0.809), and 0.809 (95% Cl = 0.768-0.850), respectively. The calibration curves showed consistency between the actual observation and nomogram. The risk stratification was also significant distinction (P < 0.05).

CONCLUSION: Tumor size and stage were related to the risk of CVD death for breast cancer patients with CT or RT. The management of CVD death risk in breast cancer patients with CT or RT should focus not only on CVD risk factors but also on tumor size and stage.

PMID:37229229 | PMC:PMC10203988 | DOI:10.3389/fcvm.2023.1149633

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PubMed articles on: Cardio-Oncology

Barbed palatal surgery: single stage or multilevel setting-a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology

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PubMed articles on: Cardio-Oncology

Radiation Therapy-Induced Cardiac Toxicity

2023 May 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.

ABSTRACT

Radiation therapy is an important component in the treatment of cancer. It may play a role as an adjuvant, neoadjuvant, palliative, or definitive therapy, with or without concurrent chemotherapy. Radiation is most commonly delivered as a local/regional treatment by an external beam consisting of photons, electrons, protons, or heavy particles but may also be delivered via brachytherapy (where a sealed radiation source is placed adjacent to the target) or systemically via unsealed sources. The side effects of radiation therapy are a function of the tissues included in the radiation field. Treatment of diseases within the thoracic region, such as Hodgkin lymphoma, lung, and breast cancer, carries the risk of radiation-induced cardiovascular toxicity (RICT).

Side effects of therapeutic radiation to the heart and coronary vessels include pericarditis, coronary artery disease (CAD), arrhythmias, cardiomyopathy, valvular dysfunction, and heart failure. Pericarditis and pericardial effusions are potential short-term toxicities that may occur during or within the weeks following treatment. Long-term side effects may present in the months to years after radiation therapy, possibly as late as 20 years or more post-treatment. Late toxicities include CAD, valvular heart disease, and heart failure.

Major risk factors that increase the likelihood of RICT include higher radiation doses, adjuvant treatment with cardiotoxic chemotherapy, irradiation of the left side of the thorax, and the presence of pre-existing cardiovascular disease. Studies have correlated the mean dose of radiation received by various heart sub-structures to the incidence of major adverse cardiac events (MACE), such as hospitalization for heart failure, myocardial infarction, and even cardiac death. Given the importance of radiation therapy in treating cancer and the high prevalence of cardiovascular disease in Western populations, numerous preventive measures have been suggested and used in clinical practice, such as dose limitation, proton and particle therapy, conformal radiation therapy, and deep-inspiration breath-hold technique.

PMID:32119340 | Bookshelf:NBK554453

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PubMed articles on: Cardio-Oncology

Cardiovascular toxicity of checkpoint inhibitors: review of associated toxicity and design of the Spanish Immunotherapy Registry of Cardiovascular Toxicity

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PubMed articles on: Cardio-Oncology

Dosimetric Comparison of Hypofractionated Regimen in Breast Cancer Using Two Different Techniques: Intensity-Modulated Radiation Therapy (IMRT) and Volumetric-Modulated Arc Therapy (VMAT)

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PubMed articles on: Cardio-Oncology

The Incident Ocular Diseases Related to Chemotherapy in Cancer Patients are Associated with Increasing Risk of Incident Stroke

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PubMed articles on: Cancer & VTE/PE

Risk of Venous Thromboembolism in Multiple Myeloma Patients During the Immediate Peri-Autologous Hematopoietic Cell Transplantation Phase

Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231177678. doi: 10.1177/10760296231177678.