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Prognosis of acute coronary syndromes after radiotherapy for breast cancer.

  • Boekel, Naomi B1
  • Boekel, Lynnly Y1
  • Buddeke, Josefien2
  • Jacobse, Judy N1
  • Schaapveld, Michael1
  • Hooning, Maartje J3
  • Seynaeve, Caroline M3
  • Baaijens, Margreet H A4
  • Sonke, Gabe S5
  • Rutgers, Emiel J T6
  • Russell, Nicola S7
  • Maas, Angela H E M8
  • Vaartjes, Ilonca2
  • Aleman, Berthe M P7
  • van Leeuwen, Flora E9
  • 1 Netherlands Cancer Institute, Epidemiology, Amsterdam, The Netherlands. , (Netherlands)
  • 2 University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands; Dutch Heart Foundation, The Hague, The Netherlands. , (Netherlands)
  • 3 Erasmus MC - Cancer Institute, Medical Oncology, Rotterdam, The Netherlands. , (Netherlands)
  • 4 Erasmus MC - Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands. , (Netherlands)
  • 5 Netherlands Cancer Institute, Medical Oncology, Amsterdam, The Netherlands. , (Netherlands)
  • 6 Netherlands Cancer Institute, Surgery, Amsterdam, The Netherlands. , (Netherlands)
  • 7 Netherlands Cancer Institute, Radiation Oncology, Amsterdam, The Netherlands. , (Netherlands)
  • 8 Radboud University Medical Centre, Department of Cardiology, Nijmegen, The Netherlands. , (Netherlands)
  • 9 Netherlands Cancer Institute, Epidemiology, Amsterdam, The Netherlands. Electronic address: [email protected] , (Netherlands)
Published Article
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Publication Date
Mar 05, 2020
DOI: 10.1016/j.radonc.2020.02.007
PMID: 32146256


Breast cancer patients treated with radiotherapy are at increased risk of subsequent acute coronary syndromes (ACS). We aimed to study if radiotherapy also influences the prognosis of these ACS. We included all 398 patients diagnosed with ACS following radiotherapy from our hospital-based cohort of early breast cancer patients aged <71 years, treated 1970-2009. Cardiovascular disease incidence and cause of death were acquired through questionnaires to general practitioners and cardiologists. Internal mammary chain (IMC) irradiation delivers the highest heart doses in breast cancer radiotherapy. Hence, we compared ACS prognosis between patients treated with/without IMC-irradiation. ACS prognosis was assessed through cardiac death, death due to ACS and cardiovascular disease incidence, using multivariable Cox proportional hazard models and by estimating cumulative incidence. In total, 62% of patients with ACS had received IMC-irradiation and 38% did not (median age at ACS diagnosis, 67 years). Median time between breast cancer and ACS was 15 years. After ACS, ten-year cumulative risk of cardiac death was 35% for patients who had IMC-irradiation (95% confidence interval [95%CI] 29-41) compared to 24% (95%CI 17-31) for patients without IMC-irradiation (p = 0.04). After correction for confounders, IMC-irradiation remained associated with a less favourable prognosis of ACS compared to no IMC-irradiation (hazard ratio cardiac death = 1.7, 95%CI 1.1-2.5). Our results suggest that radiotherapy, in case of substantial heart doses,may worsen ACS prognosis. This is an important, novel finding that may impact upon the risk-based care for breast cancer survivors with ACS. Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.

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