Adjuvant Whole Breast Radiotherapy Improve Survival in Women with Heart Failure with Reduced Ejection Fraction Receiving Breast-Conserving Surgery

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

doi:10.3390/jpm11121358

Abstract

Background: to date, no data on the effect of adjuvant whole breast radiotherapy (WBRT) 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 Methods: we included 294 women with left-breast IDC at clinical stages IA–IIIC and HFrEF receiving breast-conserving surgery (BCS) followed by adjuvant WBRT or non-adjuvant WBRT. We categorized them into two groups based on their adjuvant WBRT 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). Results: in the IPTW-adjusted model, adjuvant WBRT (adjusted HR [aHR]: 0.60; 95% confidence interval [CI]: 0.44–0.94) was a significant independent prognostic factor for all-cause death (p = 0.0424), and the aHR (95% CI) of LRR and DM for adjuvant WBRT was 0.33 (0.24–0.71; p = 0.0017) and 0.37 (0.22–0.63; p = 0.0004), respectively, compared with the non-adjuvant WBRT group. Conclusion: Adjuvant WBRT was associated with a decrease in all-cause death, LRR, and DM in women with left IDC and HFrEF compared with non-adjuvant WBRT.

Highlights

Cardiovascular disease may be a complication of breast radiotherapy (RT) and the use of specific systemic agents in the treatment of breast cancer [1]
The endpoint was all-cause death in the women with left-side invasive ductal carcinoma (IDC) and heart failure with reduced ejection fraction (HFrEF) who received breast-conserving surgery (BCS) followed by adjuvant whole breast radiotherapy (WBRT)
After confounders were adjusted for, inverse probability of treatment weighting (IPTW)-adjusted models were used to determine the time from the index date to all-cause mortality in the women with left IDC and HFrEF who received BCS followed by adjuvant WBRT or non-adjuvant WBRT

Summary

Introduction

Cardiovascular disease may be a complication of breast radiotherapy (RT) and the use of specific systemic agents in the treatment of breast cancer [1]. Incidental radiation to the heart as part of the initial treatment for breast cancer can result in a range of cardiotoxic effects, including coronary artery disease, cardiomyopathy, pericardial disease, valvular dysfunction, and conduction abnormalities [2,3,4]. For all patients with left-sided breast cancers, careful treatment planning is critical to minimize cardiac exposure to radiation [1]. The association of RT with cardiotoxicity is not dependent on the presence or absence of a breast but on the volume of radiation to the heart [3,4]. Postmastectomy RT 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]

Methods

Results

Discussion

Conclusion