Adjuvant postmastectomy radiotherapy might be associated with better survival in women with heart failure receiving total mastectomy

Jiaqiang Zhang,Tian-Shyug Lee,Ming-Feng Chiang,Shao-Yin Sum,Jeng-Guan Hsu,Szu-Yuan Wu

doi:10.1186/s13014-022-02000-x

Abstract

BackgroundTo date, no data on the effect of adjuvant postmastectomy radiotherapy (PMRT) on oncologic outcomes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available in women with left-side breast invasive ductal carcinoma (IDC) and heart failure with reduced ejection fraction (HFrEF).Patients and methodsWe enrolled 646 women with left-breast IDC at clinical stages I–IIIC and HFrEF receiving radical total mastectomy (TM) followed by adjuvant PMRT or non-adjuvant PMRT. We categorized them into two groups based on their adjuvant PMRT status and compared their overall survival (OS), LRR, and DM outcomes. We calculated the propensity score and applied inverse probability of treatment weighting (IPTW) to create a pseudo-study cohort. Furthermore, we performed a multivariate analysis of the propensity score–weighted population to obtain hazard ratios (HRs).ResultsIn the IPTW-adjusted model, adjuvant PMRT (adjusted HR [aHR]: 0.52; 95% confidence interval [CI]: 0.37–0.74) was a significant independent prognostic factor for all-cause death (P = 0.0003), and the aHR (95% CI) of LRR and DM for adjuvant PMRT was 0.90 (0.79–0.96; P = 0.0356) and 0.89 (0.54–1.50; P = 0.6854), respectively, compared with the nonadjuvant PMRT group.ConclusionAdjuvant PMRT was associated with a decrease in all-cause death, and LRR in women with left IDC and HFrEF compared with nonadjuvant PMRT.

Highlights

Radiation-induced cardiovascular toxicity (RICT) is associated with a portion of the heart being placed in a radiation field [1]
invasive ductal carcinoma (IDC) and heart failure with reduced ejection fraction (HFrEF) who received total mastectomy (TM) followed by adjuvant postmastectomy radiotherapy (PMRT)) and Group 2
The endpoint was all-cause death in the women with left-side IDC and HFrEF who received TM followed by adjuvant PMRT (Group 1, case group) and in the women with left IDC and HFrEF who received TM and had no adjuvant PMRT (Group 2, control group)

Summary

Introduction

Radiation-induced cardiovascular toxicity (RICT) is associated with a portion of the heart being placed in a radiation field [1]. For patients with left-sided breast cancers, careful treatment planning and usage of contemporary radiotherapy (RT) techniques are critical to minimize cardiac exposure to radiation [1]. Incidental irradiation dose to the heart as part of the initial treatment for breast cancer can result in a range of cardiotoxic effects, including coronary artery disease (CAD), cardiomyopathy, pericardial disease, valvular dysfunction, and conduction abnormalities [2,3,4]. Postmastectomy RT (PMRT) is more often associated with cardiac disease relative to postlumpectomy RT, but this is likely a result of the usually larger irradiated volumes of the heart in postmastectomy RT [5, 6]. We wanted to address the values of adjuvant PMRT for breast cancer patients with heart failure (HF) receiving TM with large RT field and high dose-volume to the normal heart. No data on the effect of adjuvant postmastectomy radiotherapy (PMRT) on oncologic out‐ comes, such as all-cause death, locoregional recurrence (LRR), and distant metastasis (DM), are available in women with left-side breast invasive ductal carcinoma (IDC) and heart failure with reduced ejection fraction (HFrEF)

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Discussion

Conclusion