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Liu Q, Zhang W, Li Q, Chen L, Wang X, Wang Z, Wang Y, Wang J. Risk of cerebrovascular disease after cancer diagnosis in the United States. iScience 2023; 26:107165. [PMID: 37456860 PMCID: PMC10344795 DOI: 10.1016/j.isci.2023.107165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/22/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
The risk of subsequent cerebrovascular disease among cancer patients of multiple cancers in the US is not well understood. A total of 3,843,261 cancer patients diagnosed from 1975 to 2018, were included from the surveillance, epidemiology, and end results (SEER) database. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) were estimated. The overall cerebrovascular disease SMR was 1.04 (95% CI, 1.03-1.04), and the AER per 10,000 person-years at risk was 0.89. When compared with the US general population, greater cerebrovascular disease risk was correlated with certain cancer sites, American Indian/Alaska Native race, Asian or Pacific Islander race, unmarried marital status, distant metastasis, younger age, and an earlier time of cancer diagnosis. Clinically, more precision and proactive strategies for cerebrovascular disease prevention are required to subgroup of cancer patients with a greater risk of cerebrovascular disease, especially within the first two months.
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Affiliation(s)
- Qiang Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenxiang Zhang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qi Li
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Chen
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yipeng Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Turner M, Murchie P, Derby S, Ong AY, Walji L, McLernon D, Macleod MJ, Adam R. Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis. J Cancer Surviv 2022; 16:1414-1448. [PMID: 34739710 PMCID: PMC9630245 DOI: 10.1007/s11764-021-01122-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Existing research hints that people living with and beyond cancer are at an increased risk of stroke. However, there is insufficient evidence to appropriately inform guidelines for specific stroke prevention or management for cancer patients. We conducted a systematic review and meta-analysis to describe and quantify stroke incidence in people living with and beyond cancer. METHODS Medline, CINAHL, and EMBASE were searched for epidemiological studies comparing stroke incidence between cancer and non-cancer patients. Reviewers independently extracted data; random-effects meta-analyses and quality assessment were performed. RESULTS Thirty-six studies were narratively synthesised. Meta-analysis was conducted using seven studies. Methodological quality was high for most studies. Study populations were heterogeneous, and the length of follow-up and risk factors varied. There was a variation in risk between different cancer types and according to stroke type: pancreatic (HR 2.85 (95% CI 2.43-3.36), ischaemic) (HR 2.28 (95% CI 1.43-3.63), haemorrhagic); lung (HR 2.33 (95% CI 1.63-3.35), ischaemic) (HR 2.14 (95% CI 1.45-3.15), haemorrhagic); and head and neck (HR 1.54 (95% CI 1.40-1.69), haemorrhagic) cancers were associated with significantly increased incidence of stroke. Risk is highest within the first 6 months of diagnosis. Narrative synthesis indicated that several studies also showed significantly increased incidence of stroke in individuals with colorectal cancer, breast cancer, ovarian cancer, nasopharyngeal cancer, leukaemia, and myeloma, and those who have received radiotherapy for head and neck cancers and platinum-based chemotherapy may also have higher stroke incidence. CONCLUSIONS Stroke incidence is significantly increased after diagnosis of certain cancers. IMPLICATIONS FOR CANCER SURVIVORS Cardiovascular risk should be assessed during cancer survivorship care, with attention to modifying shared cancer/cardiovascular risk factors.
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Affiliation(s)
- Melanie Turner
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Sarah Derby
- Institute of Cancer Sciences, University of Glasgow, Wolfson Wohl Cancer Research Centre, Bearsden, Glasgow, G61 1BD, UK
| | - Ariel Yuhan Ong
- Oxford Eye Hospital, Level Lg1 John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Lauren Walji
- University of Aberdeen Medical School, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - David McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Mary-Joan Macleod
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Rosalind Adam
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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Is radiation-induced arteriopathy in long-term breast cancer survivors an underdiagnosed situation?: Critical and pragmatic review of available literature. Radiother Oncol 2021; 157:163-174. [PMID: 33515666 DOI: 10.1016/j.radonc.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/01/2021] [Accepted: 01/10/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Although considered exceptional, radiation-induced arteriopathy in long-term breast cancer survivors involves three main arterial domains in the irradiated volume, namely axillary-subclavian, coronary, and carotid. Stenosis of medium-large arteries is caused by "accelerated" atherosclerosis, particularly beyond 10 years after long-forgotten radiotherapy. The present review aims at summarizing what is known about arteriopathy, as well as the state of the art in terms of diagnosis and therapeutic management. DIAGNOSIS Pauci-symptomatic over years, the usual clinical presentation of arteriopathy involves arm pain with coldness due to subacute or critical ischemia (arterial occlusion), wrongly attributed to an exclusive neurological disorder, and more rarely transient ischemic accident or angina. Evaluation of the supra-aortic trunks by computed tomography and/or magnetic resonance angiography visualizes artery lesions, while Doppler ultrasonography in expert hands assesses diagnosis and downstream functional impact. In severe cases, more invasive angiography directly visualizes long irregular arterial stenosis (full-field radiotherapy), allowing accurate prognosis and treatment. MANAGEMENT Requires early diagnosis to enable initiation of medical treatment that increases blood flow (aspirin) as soon as moderate stenosis is detected, combined with correction of vascular risk factors. In intermediate cases, these therapeutic measures are completed by revascularization strategies using transluminal angioplasty-stenting (wall thickness). Antifibrotic treatment is useful in advanced cases with combined radiation injuries. CONCLUSION In follow-up of long-term breast cancer survivors with node irradiation, myocardial infarction is treated even if radiotherapy is forgotten, while recognition and diagnosis of chronic arm ischemia due to subclavian artery stenosis needs to be improved for appropriate therapeutic management.
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Zhang F, Wang K, Du P, Yang W, He Y, Li T, Mei Z. Risk of Stroke in Cancer Survivors: A Meta-analysis of Population-Based Cohort Studies. Neurology 2020; 96:e513-e526. [PMID: 33277416 DOI: 10.1212/wnl.0000000000011264] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Accumulating evidence suggests that cancer survivors may have a relatively higher risk of stroke. The aim of this meta-analysis was to determine whether cancer survivors have a relatively higher risk of stroke than cancer-free populations on the basis of published data from population-based cohort studies. METHODS PubMed, Embase, and Cochrane Library were searched from inception to February 8, 2020, for population-based cohort studies. Effect estimates with 95% confidence intervals (CIs) were pooled using the random-effects model. We conducted subgroup analyses and meta-regression to explore sources of heterogeneity and the stability of the results. RESULTS Twenty population-based cohort studies involving 10,479,530 participants were identified. Overall, the relative risk (RR) for stroke in cancer survivors was 1.66 (95% CI 1.35-2.04; p < 0.001) compared with that in cancer-free controls; survivors of head and neck, hematologic, lung, pancreas, and stomach cancer (all p < 0.05) showed consistently significant results, whereas no significant increased risk was observed for patients with other cancer types. The effects were more prominent in cancer survivors with female sex (RR 1.38, 95% CI 1.18-1.61; p < 0.001), younger age at cancer diagnosis (<45 years) (RR 2.57, 95% CI 1.27-5.19; p = 0.009), and shorter cancer survival duration (≥1-2 years) (RR 1.69, 95% CI 1.18-2.42; p = 0.004). Moreover, cancer survivors had a significantly increased risk of ischemic stroke (RR 1.53, 95% CI 1.28-1.84; p < 0.001) compared with hemorrhagic stroke. CONCLUSIONS Cancer plays a critical role in the etiologic of stroke. Due to the existence of substantial heterogeneity among the included studies, the results should be interpreted with caution. However, early prevention and effective intervention of stroke in cancer survivors require attention from health policy makers.
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Affiliation(s)
- Fangfang Zhang
- From the Second Department of Neurology (F.Z., K.W.), Xinxiang Central Hospital, Henan Province; Department of Anorectal Surgery (P.D., W.Y., Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (P.D., W.Y., Z.M.), Shanghai, China; Usher Institute of Population Health Sciences (Y.H.), University of Edinburgh, UK; and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China
| | - Kuanhong Wang
- From the Second Department of Neurology (F.Z., K.W.), Xinxiang Central Hospital, Henan Province; Department of Anorectal Surgery (P.D., W.Y., Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (P.D., W.Y., Z.M.), Shanghai, China; Usher Institute of Population Health Sciences (Y.H.), University of Edinburgh, UK; and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China
| | - Peixin Du
- From the Second Department of Neurology (F.Z., K.W.), Xinxiang Central Hospital, Henan Province; Department of Anorectal Surgery (P.D., W.Y., Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (P.D., W.Y., Z.M.), Shanghai, China; Usher Institute of Population Health Sciences (Y.H.), University of Edinburgh, UK; and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China.
| | - Wei Yang
- From the Second Department of Neurology (F.Z., K.W.), Xinxiang Central Hospital, Henan Province; Department of Anorectal Surgery (P.D., W.Y., Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (P.D., W.Y., Z.M.), Shanghai, China; Usher Institute of Population Health Sciences (Y.H.), University of Edinburgh, UK; and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China
| | - Yazhou He
- From the Second Department of Neurology (F.Z., K.W.), Xinxiang Central Hospital, Henan Province; Department of Anorectal Surgery (P.D., W.Y., Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (P.D., W.Y., Z.M.), Shanghai, China; Usher Institute of Population Health Sciences (Y.H.), University of Edinburgh, UK; and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China.
| | - Tian Li
- From the Second Department of Neurology (F.Z., K.W.), Xinxiang Central Hospital, Henan Province; Department of Anorectal Surgery (P.D., W.Y., Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (P.D., W.Y., Z.M.), Shanghai, China; Usher Institute of Population Health Sciences (Y.H.), University of Edinburgh, UK; and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China.
| | - Zubing Mei
- From the Second Department of Neurology (F.Z., K.W.), Xinxiang Central Hospital, Henan Province; Department of Anorectal Surgery (P.D., W.Y., Z.M.), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine; Anorectal Disease Institute of Shuguang Hospital (P.D., W.Y., Z.M.), Shanghai, China; Usher Institute of Population Health Sciences (Y.H.), University of Edinburgh, UK; and School of Basic Medicine (T.L.), Fourth Military Medical University, Xi'an, China.
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Koppelmans V, van der Willik KD, Aleman BMP, van Leeuwen FE, Kavousi M, Arshi B, Vernooij MW, Ikram MA, Schagen SB. Long-term effects of adjuvant treatment for breast cancer on carotid plaques and brain perfusion. Breast Cancer Res Treat 2020; 186:167-176. [PMID: 33151443 PMCID: PMC7940271 DOI: 10.1007/s10549-020-05990-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/05/2020] [Indexed: 12/05/2022]
Abstract
Purpose Breast cancer treatment has been associated with vascular pathology. It is unclear if such treatment is also associated with long-term cerebrovascular changes. We studied the association between radiotherapy and chemotherapy with carotid pathology and brain perfusion in breast cancer survivors. Methods We included 173 breast cancer survivors exposed to radiotherapy and chemotherapy, assessed ± 21.2 years after cancer diagnosis, and 346 age-matched cancer-free women (1:2) selected from the population-based Rotterdam Study. Outcome measures were carotid plaque score, intima-media thickness (IMT), total cerebral blood flow (tCBF), and brain perfusion. Additionally, we investigated the association between inclusion of the carotid artery in the radiation field (no/small/large part), tumor location, and these outcome measures within cancer survivors. Results Cancer survivors had lower tCBF (− 19.6 ml/min, 95%CI − 37.3;− 1.9) and brain perfusion (− 2.5 ml/min per 100 ml, 95%CI − 4.3;− 0.7) than cancer-free women. No statistically significant group differences were observed regarding plaque score or IMT. Among cancer survivors, a large versus a small part of the carotid artery in the radiation field was associated with a higher IMT (0.05, 95%CI0.01;0.09). Also, survivors with a right-sided tumor had lower left carotid plaque score (− 0.31, 95%CI − 0.60;− 0.02) and higher brain perfusion (3.5 ml/min per 100 ml, 95%CI 0.7;6.2) than those with a left-sided tumor. Conclusions On average two decades post-diagnosis, breast cancer survivors had lower tCBF and brain perfusion than cancer-free women. Also, survivors with a larger area of the carotid artery within the radiation field had a larger IMT. Future studies should confirm if these cerebrovascular changes underlie the frequently observed cognitive problems in cancer survivors.
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Affiliation(s)
- Vincent Koppelmans
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Psychiatry, University of Utah, Salt Lake City, USA
| | - Kimberly D. van der Willik
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Berthe M. P. Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Flora E. van Leeuwen
- Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W. Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sanne B. Schagen
- Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Psychology, Brain and Cognition, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, The Netherlands
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Chemotherapy-induced brain changes in breast cancer survivors: evaluation with multimodality magnetic resonance imaging. Brain Imaging Behav 2020; 13:1799-1814. [PMID: 30937827 DOI: 10.1007/s11682-019-00074-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chemotherapy related cognitive impairments are common in breast cancer patients undergoing chemotherapy. These cognitive dysfunctions are mainly attributable to chemotherapy related brain structural and functional alterations. Multimodality magnetic resonance imaging (MRI) can reveal brain gray matter volume loss, white matter microstructural disruption, reduced gray matter density, impaired cerebral blood flow and brain structural and functional connection networks at both local and global levels. This review outlines the potential applications of multimodality MR imaging techniques in chemotherapy induced cognitive deficit in breast cancer survivors and provides future research perspective in this field.
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Chou YH, Huang JY, Kornelius E, Chiou JY, Huang CN. Major Adverse Cardiovascular Events after Treatment in Early-stage Breast Cancer Patients Receiving Hormone Therapy. Sci Rep 2020; 10:1408. [PMID: 31996695 PMCID: PMC6989448 DOI: 10.1038/s41598-020-57726-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/30/2019] [Indexed: 11/08/2022] Open
Abstract
This nationwide population-based study investigated the differences in the risks of major adverse cardiovascular events (MACEs) among patients with hormone receptor-positive early-stage breast cancer undergoing different combinations of adjuvant treatments in Taiwan. Data from the National Health Insurance Research Database (NHIRD) and Taiwan Cancer Registry (TCR) along with the national mortality data were used. Patients who underwent surgery as the first mode of treatment were divided into four groups based on the subsequent adjuvant therapy received: hormone therapy (H), hormone therapy + chemotherapy (CH), hormone therapy + radiotherapy (RH), and hormone therapy + radiotherapy + chemotherapy (CRH) groups. The risks of fatal and nonfatal MACE among the groups were examined using the inverse probability of treatment weighted hazard ratio (IPTW-HR). Adjuvant treatment, age, tumour size, and comorbidities significantly affected the risks of MACEs among the 19,007 patients analysed. For nonfatal MACEs, the IPTW-HR was significantly lower in the CH group compare to the H group (0.704, 95% confidence interval [CI]: 0.516-0.961). No significant differences in the risks for fatal MACE were observed among the four groups. The IPTW-HRs for haemorrhagic stroke in the CH group was 0.424 (95% CI: 0.188-0.957), for congestive heart failure (CHF) in the RH group was 0.260 (95% CI: 0.088-0.762), and for ischaemic heart disease in the CRH group was 0.544 (95% CI: 0.317-0.934). Increase in the adjuvant modality does not necessarily increase the nonfatal or fatal MACE risks. Cardiac health should be monitored even in patients receiving hormone therapy alone.
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Affiliation(s)
- Ying-Hsiang Chou
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, ROC
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Edy Kornelius
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
- Division of Endocrinology and Metabolism, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Chien-Ning Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.
- Division of Endocrinology and Metabolism, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
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D’Souza M, Smedegaard L, Madelaire C, Bang C, Nielsen D, Torp-Pedersen C, Gislason G, Schou M, Fosbøl E. Atrial fibrillation and anticoagulation in patients with breast cancer. SCAND CARDIOVASC J 2019; 53:247-254. [DOI: 10.1080/14017431.2019.1638517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Maria D’Souza
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
| | - Laerke Smedegaard
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
| | - Christian Madelaire
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
| | - Casper Bang
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
- Department of Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Dorte Nielsen
- Department of Clinical Oncology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
- Department of Epidemiology, University of Aalborg, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark
- Department of Research, The Danish Heart Foundation, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
| | - Emil Fosbøl
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, Denmark
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Rajeev-Kumar G, Sarpel U, Dhamoon MS. Risk of Stroke After Colorectal Surgery for Cancerous Versus Benign Conditions. J Stroke Cerebrovasc Dis 2018; 27:3311-3319. [PMID: 30150065 DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cancer treatment, specifically surgical intervention, as a possible stroke trigger is understudied. METHODS Using the Nationwide Readmissions Database and validated diagnosis and procedure codes, we identified adults with index admissions for colorectal surgery for colorectal adenocarcinoma (Group A) and compared them to admissions for colorectal surgery for benign conditions (Group B) and hepatobiliary or pancreatic surgery for benign conditions (Group C). Within the colorectal cancer cohort, we further identified patients who underwent open versus laparoscopic surgery. The primary outcome was readmission for ischemic or hemorrhagic stroke up to 1 year. Cumulative risk of ischemic stroke was calculated using risk survival statistics, and hazard ratios (HR) were calculated using adjusted Cox regression. RESULTS Patients in Group A had higher 3-month readmission rates for ischemic and hemorrhagic strokes than those in Groups B and C. Higher risk of ischemic stroke (HR 1.46, 95% confidence interval [CI] 1.20-1.79) in Group A compared to Group B was eliminated following adjustments for illness severity and vascular risk factors. Comparing types of colorectal surgical intervention for cancer, there was significantly greater risk of ischemic stroke with open versus laparoscopic surgery, despite adjusting for vascular risk factors (HR 1.70, 95% CI 1.15-2.52). CONCLUSIONS We found elevated risk of ischemic stroke up to 1 year following open surgery for colorectal adenocarcinoma compared to laparoscopic. More research is necessary to clarify the underlying surgery-related mechanisms that contribute to elevated risk.
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Affiliation(s)
- Greeshma Rajeev-Kumar
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Umut Sarpel
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
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Gernaat SAM, Boer JMA, van den Bongard DHJ, Maas AHEM, van der Pol CC, Bijlsma RM, Grobbee DE, Verkooijen HM, Peeters PH. The risk of cardiovascular disease following breast cancer by Framingham risk score. Breast Cancer Res Treat 2018; 170:119-127. [PMID: 29492735 PMCID: PMC5993849 DOI: 10.1007/s10549-018-4723-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study evaluates the risk of cardiovascular disease (CVD) following breast cancer, accounting for baseline CVD risk. METHODS Within the EPIC-NL (Dutch part of the European Prospective Investigation into Nutrition and Cancer) cohort, 1103 women were diagnosed with breast cancer. For every breast cancer patient, 3-4 women without breast cancer (n = 4328) were selected matched for age, year, and time since cohort enrollment. Based on CVD risk factors at cohort enrollment, 10-year risk of CVD was calculated and categorized: low (< 10%), intermediate (10-20%), high (> 20%). Cox proportional hazard models assessed the risk of CVD events (hospitalization or mortality) and CVD mortality of women with versus without breast cancer, adjusted for baseline CVD risk. RESULTS After median follow-up of 5 and 6 years, 92 (8.3%) and 325 (7.5%) CVD events occurred in women with and without breast cancer, respectively. In the low CVD risk group, women with breast cancer had 1.44 (95% CI 1.00-2.06) times higher risk of CVD events than women without breast cancer. In the intermediate and high CVD risk categories, risk of CVD events was similar in women with and without breast cancer. Overall, women with breast cancer had 1.77 (95% CI 1.10-2.86) times higher risk of CVD mortality than women without breast cancer. CONCLUSIONS Among women with low CVD risk, women with breast cancer have a higher risk of CVD event than women without breast cancer. Overall, women with breast cancer have a higher risk of CVD mortality than women without breast cancer.
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Affiliation(s)
- Sofie A. M. Gernaat
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Present Address: Utrecht, The Netherlands
| | - Jolanda M. A. Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Utrecht University, Bilthoven, Utrecht, The Netherlands
| | | | - Angela H. E. M. Maas
- Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | | | - Rhodé M. Bijlsma
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederick E. Grobbee
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Helena M. Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Petra H. Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
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12
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Lai SW, Lin CL, Liao KF. Tamoxifen Use Correlates with Increased Risk of the First Episode of Ischemic Cerebrovascular Disease in Older Women with Breast Cancer: A Case-Control Study in Taiwan. Front Pharmacol 2017; 8:742. [PMID: 29089895 PMCID: PMC5651079 DOI: 10.3389/fphar.2017.00742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: There are inconsistent results about the association between ischemic cerebrovascular disease and tamoxifen use in women with breast cancer. The study aimed to evaluate the association between the risk of ischemic cerebrovascular disease and tamoxifen use in older women with breast cancer in Taiwan. Methods: We designed a retrospective, nationwide, case-control study using the database of the Taiwan National Health Insurance Program. A total of 800 female subjects with breast cancer aged ≥65 years with the first episode of ischemic cerebrovascular disease from 2000 to 2011 were identified as the cases. Additionally, 2,876 female subjects with breast cancer aged ≥65 years without any type of cerebrovascular diseases were selected as the control subjects. The cases and the control subjects were matched with age and comorbidities. Ever use of tamoxifen was defined as a subject who had at least a prescription for tamoxifen before the index date. Never use of tamoxifen was defined as a subject who never had a prescription for tamoxifen before the index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) for ischemic cerebrovascular disease associated with tamoxifen use. Results: After adjusting for confounding variables, the adjusted OR of ischemic cerebrovascular disease was 2.5 for subjects with ever use of tamoxifen (95% CI 2.10, 2.97), compared with never use of tamoxifen. In addition, the adjusted OR of ischemic cerebrovascular disease was 1.15 (95% CI 1.10, 1.21) in subjects with ever use of tamoxifen as increase in use duration per 1 year. The adjusted OR of ischemic cerebrovascular disease was 2.54 (95% CI 2.03, 3.17) in subjects with ever use of tamoxifen as increase in dosage per 1 mg. Conclusions: Tamoxifen use is significantly associated with 2.5-fold increased odds of ischemic cerebrovascular disease among older women with breast cancer in Taiwan. There are duration-dependent and dose-dependent effects of tamoxifen use on the risk of ischemic cerebrovascular disease.
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Affiliation(s)
- Shih-Wei Lai
- Department of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Department of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
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Blaes A, Beckwith H, Florea N, Hebbel R, Solovey A, Potter D, Yee D, Vogel R, Luepker R, Duprez D. Vascular function in breast cancer survivors on aromatase inhibitors: a pilot study. Breast Cancer Res Treat 2017; 166:541-547. [PMID: 28801846 DOI: 10.1007/s10549-017-4447-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Aromatase inhibitors (AI) have been shown to reduce breast cancer-related mortality in women with estrogen positive (ER+) breast cancer. The use of AIs, however, has been associated with higher rates of hypertension, hyperlipidemia, and cardiovascular (CV) events. METHODS A cross-sectional study of 25 healthy postmenopausal women and 36 women with curative intent breast cancer on an AI was performed to assess endothelial dysfunction, an indicator of risk for CV events. Consented subjects underwent vascular testing using the HDI/Pulse Wave CR-2000 Cardiovascular Profiling System and the EndoPAT2000 system. RESULTS Mean age was 61.7 and 59.6 years (cases, controls). Most subjects were Caucasian and overweight. Controls had a lower mean systolic blood pressure (128.6 mmHg vs. 116.2 mmHg, p = 0.004). Median estradiol levels were reduced in cases (2 vs. 15 pg/ml, p < 0.0001). EndoPAT ratio (0.8 vs. 2.7, p < 0.0001) was significantly reduced in cases as compared to controls. Median large artery elasticity (12.9 vs. 14.6 ml/mmHg × 10, p = 0.12) and small artery elasticity (5.2 vs. 7.0 ml/mmHg × 100, p = 0.07) were also reduced though not statistically significant. There was no correlation between use of chemotherapy, radiation therapy, type of AI, or duration of AI use and endothelial function. When adjusting for differences in blood pressure, results remained significant. CONCLUSION Breast cancer cases on AIs have reductions in endothelial function, a predictor of adverse CV disease. IMPACT Vascular function changes in breast cancer cases on AIs compared to postmenopausal women. Further work is needed to evaluate vascular changes over time.
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Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA. .,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
| | - Heather Beckwith
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Natalia Florea
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Robert Hebbel
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
| | - Anna Solovey
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
| | - David Potter
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Douglas Yee
- Division of Hematology/Oncology, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Rachel Vogel
- Division of Gynecology/Oncology, University of Minnesota, Minneapolis, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Russell Luepker
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Duprez
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
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Shibahara I, Watanabe T, Ezura M, Inoue T, Fujimura M, Kimura N, Inoue T, Suzuki I, Nishino A, Nishimura S, Uenohara H, Tominaga T. Clinical features of subarachnoid hemorrhage in patients with positive cancer history. J Neurooncol 2016; 128:129-136. [DOI: 10.1007/s11060-016-2085-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
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15
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Benito-León J, Aleja JGDL, Martínez-Salio A, Louis ED, Lichtman JH, Bermejo-Pareja F. Symptomatic Atherosclerotic Disease and Decreased Risk of Cancer-Specific Mortality: A Prospective, Population-Based Study (NEDICES). Medicine (Baltimore) 2015; 94:e1287. [PMID: 26266364 PMCID: PMC4616691 DOI: 10.1097/md.0000000000001287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The few studies that have assessed the association between symptomatic atherosclerotic disease and risk of cancer have had conflicting results. In addition, these studies ascertained participants either from treatment settings (ie, service-based studies) or by using a records linkage system (ie, medical records of patients evaluated at clinics or hospitals) and, therefore, were prone to selection bias. Our purpose was to estimate the risk of cancer mortality in a large population-based sample of elderly people, comparing participants with symptomatic atherosclerotic disease (atherosclerotic stroke and coronary disease) to their counterparts without symptomatic atherosclerotic disease (ie, controls) in the same population.In this population-based, prospective study (Neurological Disorders of Central Spain, NEDICES), 5262 elderly community-dwelling participants with and without symptomatic atherosclerotic disease were identified and followed for a median of 12.1 years, after which the death certificates of those who died were reviewed.A total of 2701 (53.3%) of 5262 participants died, including 314 (68.6%) of 458 participants with symptomatic atherosclerotic disease and 2387 (49.7%) of 4804 controls. Cancer mortality was reported significantly less often in those with symptomatic atherosclerotic disease (15.6%) than in controls (25.6%) (P < 0.001). In an unadjusted Cox model, risk of cancer-specific mortality was decreased in participants with symptomatic atherosclerotic disease (HR = 0.74, 95% confidence interval [CI], 0.55-0.98, P = 0.04) vs. those without symptomatic atherosclerotic disease (reference group). In an adjusted Cox model, HR = 0.58; 95% CI, 0.38-0.89; P = 0.01.This population-based, prospective study suggests that there is an inverse association between symptomatic atherosclerotic disease and risk of cancer mortality.
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Affiliation(s)
- Julián Benito-León
- From the Department of Neurology, University Hospital "12 de Octubre" (JB-L, JGdlA, AM-S, FB-P); Department of Medicine, Faculty of Medicine, Complutense University (JB-L, JGdlA, AM-S, FB-P); Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain (JB-L, FB-P); Department of Neurology, Yale School of Medicine (EDL); Department of Chronic Disease Epidemiology, Yale School of Public Health (EDL, JHL); and Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine and Yale School of Public Health, New Haven, CT, USA (EDL, JHL)
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16
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Koppelmans V, Vernooij MW, Boogerd W, Seynaeve C, Ikram MA, Breteler MM, Schagen SB. Prevalence of Cerebral Small-Vessel Disease in Long-Term Breast Cancer Survivors Exposed to Both Adjuvant Radiotherapy and Chemotherapy. J Clin Oncol 2015; 33:588-93. [DOI: 10.1200/jco.2014.56.8345] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Adjuvant radiotherapy and chemotherapy for breast cancer have been related to transient ischemic attacks and stroke. To date, no studies have investigated the relationship between these adjuvant therapies and subclinical cerebral small-vessel disease in survivors of breast cancer. We compared white matter lesion (WML) volume and prevalence of brain infarctions and cerebral microbleeds (CMBs) between breast cancer survivors exposed to adjuvant radiotherapy and chemotherapy (aRCeBCSs) for primary disease and a population-based reference group. Patients and Methods Multimodal magnetic resonance imaging (1.5 T) was performed in 187 aRCeBCSs who received primary breast cancer treatment on average more than 20 years before this study and 374 age-matched reference women without a history of cancer. WML volume was segmented using fully automated software. Experienced raters reviewed all scans for cortical infarctions, lacunar infarctions, strictly lobar CMBs, and deep/infratentorial CMBs with or without lobar CMBs. Within the aRCeBCS group, we also analyzed the association between relative radiotherapy exposure to the carotid artery and prevalence of WML volume and CMBs. Results The aRCeBCS group had a higher prevalence of both total CMBs and CMBs in a deep/infratentorial region than the reference group. No between-group differences were observed in the prevalence of infarctions or WML volume. Exposure of the carotid artery to radiation was not associated with WML volume or CMBs. Conclusion More CMBs were found in the aRCeBCS group than in the population-based controls. These vascular lesions potentially mark cerebrovascular frailty that could partially explain the well-documented association between chemotherapy and cognitive dysfunction. No support was found for a radiotherapy-related origin of CMBs.
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Affiliation(s)
- Vincent Koppelmans
- Vincent Koppelmans, University of Michigan, School of Kinesiology, Ann Arbor, MI; Vincent Koppelmans, Meike W. Vernooij, Caroline Seynaeve, and M. Arfan Ikram, Erasmus University Medical Center, Rotterdam; Vincent Koppelmans, Willem Boogerd, and Sanne B. Schagen, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; and Monique M.B. Breteler, German Center for Neurodegenerative Diseases and University of Bonn, Institute for Medical Biometry, Informatics, and
| | - Meike W. Vernooij
- Vincent Koppelmans, University of Michigan, School of Kinesiology, Ann Arbor, MI; Vincent Koppelmans, Meike W. Vernooij, Caroline Seynaeve, and M. Arfan Ikram, Erasmus University Medical Center, Rotterdam; Vincent Koppelmans, Willem Boogerd, and Sanne B. Schagen, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; and Monique M.B. Breteler, German Center for Neurodegenerative Diseases and University of Bonn, Institute for Medical Biometry, Informatics, and
| | - Willem Boogerd
- Vincent Koppelmans, University of Michigan, School of Kinesiology, Ann Arbor, MI; Vincent Koppelmans, Meike W. Vernooij, Caroline Seynaeve, and M. Arfan Ikram, Erasmus University Medical Center, Rotterdam; Vincent Koppelmans, Willem Boogerd, and Sanne B. Schagen, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; and Monique M.B. Breteler, German Center for Neurodegenerative Diseases and University of Bonn, Institute for Medical Biometry, Informatics, and
| | - Caroline Seynaeve
- Vincent Koppelmans, University of Michigan, School of Kinesiology, Ann Arbor, MI; Vincent Koppelmans, Meike W. Vernooij, Caroline Seynaeve, and M. Arfan Ikram, Erasmus University Medical Center, Rotterdam; Vincent Koppelmans, Willem Boogerd, and Sanne B. Schagen, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; and Monique M.B. Breteler, German Center for Neurodegenerative Diseases and University of Bonn, Institute for Medical Biometry, Informatics, and
| | - M. Arfan Ikram
- Vincent Koppelmans, University of Michigan, School of Kinesiology, Ann Arbor, MI; Vincent Koppelmans, Meike W. Vernooij, Caroline Seynaeve, and M. Arfan Ikram, Erasmus University Medical Center, Rotterdam; Vincent Koppelmans, Willem Boogerd, and Sanne B. Schagen, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; and Monique M.B. Breteler, German Center for Neurodegenerative Diseases and University of Bonn, Institute for Medical Biometry, Informatics, and
| | - Monique M.B. Breteler
- Vincent Koppelmans, University of Michigan, School of Kinesiology, Ann Arbor, MI; Vincent Koppelmans, Meike W. Vernooij, Caroline Seynaeve, and M. Arfan Ikram, Erasmus University Medical Center, Rotterdam; Vincent Koppelmans, Willem Boogerd, and Sanne B. Schagen, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; and Monique M.B. Breteler, German Center for Neurodegenerative Diseases and University of Bonn, Institute for Medical Biometry, Informatics, and
| | - Sanne B. Schagen
- Vincent Koppelmans, University of Michigan, School of Kinesiology, Ann Arbor, MI; Vincent Koppelmans, Meike W. Vernooij, Caroline Seynaeve, and M. Arfan Ikram, Erasmus University Medical Center, Rotterdam; Vincent Koppelmans, Willem Boogerd, and Sanne B. Schagen, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; and Monique M.B. Breteler, German Center for Neurodegenerative Diseases and University of Bonn, Institute for Medical Biometry, Informatics, and
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17
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Garcez K, Lim CC, Whitehurst P, Thomson D, Ho KF, Lowe M, Sykes A, Lee LW, Yap B, Slevin N. Carotid dosimetry for T1 glottic cancer radiotherapy. Br J Radiol 2014; 87:20130754. [PMID: 24628251 PMCID: PMC4075556 DOI: 10.1259/bjr.20130754] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/05/2014] [Accepted: 02/11/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Radiotherapy for T1 glottic cancer is commonly delivered using a lateral parallel opposed pair of megavoltage photon fields. There is increasing reported evidence of cerebrovascular events due to radiation-induced carotid stenosis. An alternative field arrangement is to use an anterior oblique technique. This study compares the carotid dosimetry between the two techniques and reviews the evidence for the risk of radiation-induced vascular events. METHODS The radiotherapy plans of 10 patients with T1 glottic cancer treated with an anterior oblique technique were examined for carotid dose. Alternative plans were then created using a parallel opposed pair of fields and the dose to the carotids compared. All patients received 50 Gy in 16 fractions treating once daily, for 5 days in a week. RESULTS The average of the mean dose to the carotids with the anterior oblique technique was 21 Gy compared with 37 Gy using the lateral parallel opposed pair arrangement (p < 0.0001). CONCLUSION An anterior oblique field arrangement for the treatment of T1 glottic cancer results in a significantly lower radiation dose to the carotid arteries, which may be clinically important in terms of reducing the risk of cerebrovascular events in long-term survivors. ADVANCES IN KNOWLEDGE Although the anterior oblique technique for treating early glottic cancers is well described, and it is predictable that the dose received by the carotid arteries should be lower with this technique, to our knowledge this is the first study to quantify that reduction in dose with a series of patients.
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Affiliation(s)
- K Garcez
- Department of Clinical Oncology, Christie Hospital, Manchester, UK
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18
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Radiation-induced carotid artery atherosclerosis. Radiother Oncol 2013; 110:31-8. [PMID: 24044796 DOI: 10.1016/j.radonc.2013.08.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 06/05/2013] [Accepted: 08/07/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Carotid arteries frequently receive significant doses of radiation as collateral structures in the treatment of malignant diseases. Vascular injury following treatment may result in carotid artery stenosis (CAS) and increased risk of stroke and transient ischaemic attack (TIA). This systematic review examines the effect of radiotherapy (RT) on the carotid arteries, looking at the incidence of stroke in patients receiving neck radiotherapy. In addition, we consider possible surrogate endpoints such as CAS and carotid intima-medial thickness (CIMT) and summarise the evidence for radiation-induced carotid atherosclerosis. MATERIALS AND METHODS From 853 references, 34 articles met the criteria for inclusion in this systematic review. These papers described 9 studies investigating the incidence of stroke/TIA in irradiated patients, 11 looking at CAS, and 14 examining CIMT. RESULTS The majority of studies utilised suboptimally-matched controls for each endpoint. The relative risk of stroke in irradiated patients ranged from 1.12 in patients with breast cancer to 5.6 in patients treated for head and neck cancer. The prevalence of CAS was increased by 16-55%, with the more modest increase seen in a study using matched controls. CIMT was increased in irradiated carotid arteries by 18-40%. Only two matched-control studies demonstrated a significant increase in CIMT of 36% and 22% (p=0.003 and <0.001, respectively). Early prospective data demonstrated a significant increase in CIMT in irradiated arteries at 1 and 2 years after RT (p<0.001 and <0.01, respectively). CONCLUSIONS The incidence of stroke was significantly increased in patients receiving RT to the neck. There was a consistent difference in CAS and CIMT between irradiated and unirradiated carotid arteries. Future studies should optimise control groups.
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Koppelmans V, de Groot M, de Ruiter MB, Boogerd W, Seynaeve C, Vernooij MW, Niessen WJ, Schagen SB, Breteler MMB. Global and focal white matter integrity in breast cancer survivors 20 years after adjuvant chemotherapy. Hum Brain Mapp 2012; 35:889-99. [PMID: 23281152 DOI: 10.1002/hbm.22221] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 07/25/2012] [Accepted: 10/11/2012] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To date, only four small studies have investigated the effects of adjuvant chemotherapy for breast cancer on the microstructure of cerebral white matter with magnetic resonance imaging (MRI). These studies, which were conducted shortly up to 10 years post-treatment, showed that chemotherapy is associated with focal loss of microstructural white matter integrity. We investigated the long-term effect of chemotherapy on white matter microstructural integrity by comparing the brains of chemotherapy-exposed breast cancer survivors to those of a population-based sample of women without a history of cancer. EXPERIMENTAL DESIGN Diffusion tensor imaging (DTI) MRI (1.5 T) was performed in 187 CMF (cyclophosphamide, methotrexate, and 5-flourouracil) chemotherapy-exposed breast cancer survivors, mean age 64.2 (sd = 6.5) years, who had been diagnosed with cancer on average 21.2 (sd = 4.4) years before, and 374 age-matched cancer-free reference subjects from a population-based cohort study. Outcome measures were whole-brain microstructural integrity as measured by fractional anisotropy and mean/axial/radial diffusivity and focal white matter integrity, which was analyzed with tract-based spatial statistics. All analyses were adjusted for age, cardiovascular risk factors, education, and symptoms of depression. PRINCIPAL OBSERVATIONS No significant group differences were observed in white matter integrity. However, within the breast cancer survivors, time since treatment was inversely associated with lower global and focal white matter integrity. CONCLUSIONS This cross-sectional study suggests that among chemotherapy-exposed breast cancer survivors white matter microstructural integrity deteriorates with accumulating time since treatment. This warrants further investigation.
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Affiliation(s)
- Vincent Koppelmans
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Psychosocial Research & Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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20
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Khouri MG, Douglas PS, Mackey JR, Martin M, Scott JM, Scherrer-Crosbie M, Jones LW. Cancer therapy-induced cardiac toxicity in early breast cancer: addressing the unresolved issues. Circulation 2012; 126:2749-63. [PMID: 23212997 PMCID: PMC3667651 DOI: 10.1161/circulationaha.112.100560] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | | | | | - Miguel Martin
- Hospital General Universitario Gregorio Maranon, Universidad Complutense, Madrid, Spain
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Mulrooney DA, Blaes AH, Duprez D. Vascular injury in cancer survivors. J Cardiovasc Transl Res 2012; 5:287-95. [PMID: 22456863 DOI: 10.1007/s12265-012-9358-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 03/04/2012] [Indexed: 12/28/2022]
Abstract
With an increase in the number of patients surviving many years following successful cancer treatment, has come an improved understanding of the long-term effects of cancer therapy and its implications on future health. Premature cardiovascular disease is a significant cause of early morbidity and the leading non-cancer cause of death in this population. Chemotherapeutic agents and radiation therapy are known to be cardiotoxic. However, numerous vascular-related toxicities have also been observed among cancer survivors, such as myocardial ischemia, transient ischemic attacks, and stroke, suggesting a degree of chronic endothelial injury and dysfunction leading to premature atherosclerotic disease. Vascular health in cancer survivors may be further compromised by metabolic abnormalities such as obesity, insulin resistance, and dyslipidemias which have also been reported following cancer therapy. Furthermore, some survivors experience gonadal dysfunction and loss of potentially protective sex steroids or undergo hormonal therapies that induce additional metabolic abnormalities. The effects of cancer therapies upon the endothelial monolayer have not been fully explored. An understanding of potential injury to and dysfunction of the circulatory system among cancer survivors is essential for identifying preventive strategies and therapeutic targets.
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Affiliation(s)
- Daniel A Mulrooney
- Division of Cancer Survivorship, Department of Oncology, St Jude Children's Research Hospital, Mail Stop 735, 262 Danny Thomas Place, Memphis, TN 38105, USA.
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22
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Rogers LR. Neurovascular complications of solid tumors and hematological neoplasms. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:805-23. [PMID: 22230535 DOI: 10.1016/b978-0-444-53502-3.00025-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Haque R, Yood MU, Geiger AM, Kamineni A, Avila CC, Shi J, Silliman RA, Quinn VP. Long-term safety of radiotherapy and breast cancer laterality in older survivors. Cancer Epidemiol Biomarkers Prev 2011; 20:2120-6. [PMID: 21878589 DOI: 10.1158/1055-9965.epi-11-0348] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although adjuvant radiotherapy (RT) following surgery for breast cancer improves overall survival, controversy exists about its long-term adverse impact on cardiovascular health in older survivors. AIM To determine whether incident cardiovascular disease (CVD) is associated with RT and whether tumor laterality modifies this association. METHODS Women aged 65+ years diagnosed with stage I and II breast cancer between 1990 and 1994 were identified from three health plans. Women were followed through CVD outcomes, health plan disenrollment, death, or study end (December 31, 2004). The main independent variable was RT use. Adjusted HRs and 95% CIs were estimated using Cox proportional hazards models with time-dependent tamoxifen and RT use status. We adjusted for age, race, stage, estrogen receptor/progesterone receptor, hypertension, and diabetes. RESULTS In the full cohort (N = 806), RT was not associated with greater risk of CVD (maximum follow-up was 14 years). However, within the RT-exposed group (N = 340), women treated for left-side breast cancer had a significant increased risk of CVD outcomes (HR = 1.53, 95% CI: 1.06-2.21) compared with women with right-sided tumors. CONCLUSION Laterality is critical to understanding the effect of RT on CVD. Studies of more contemporary cohorts of women treated with RT should incorporate this variable to determine whether the risk persists with refinements in the dosing and delivery of RT. IMPACT As some irradiation to the heart is unavoidable even with refined modern RT techniques, continued effort is required to minimize such exposures, especially in older women with left-sided tumors.
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Affiliation(s)
- Reina Haque
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA 91101, USA.
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Plummer C, Henderson RD, O'Sullivan JD, Read SJ. Ischemic stroke and transient ischemic attack after head and neck radiotherapy: a review. Stroke 2011; 42:2410-8. [PMID: 21817150 DOI: 10.1161/strokeaha.111.615203] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebrovascular disease can complicate head and neck radiotherapy and result in transient ischemic attack and ischemic stroke. Although the incidence of radiation vasculopathy is predicted to rise with improvements in median cancer survival, the pathogenesis, natural history, and management of the disease are ill defined. METHODS We examined studies on the epidemiology, imaging, pathogenesis, and management of medium- and large-artery intra- and extra-cranial disease after head and neck radiotherapy. Controlled prospective trials and larger retrospective trials from the last 30 years were prioritized. RESULTS The relative risk of transient ischemic attack or ischemic stroke is at least doubled by head and neck radiotherapy. Chronic radiation vasculopathy affecting medium and large intra- and extra-cranial arteries is characterized by increasing rates of hemodynamically significant stenosis with time from radiotherapy. Disease expression is the likely consequence of the combined radiation insult to the intima-media (accelerating atherosclerosis) and to the adventitia (injuring the vasa vasorum). Optimal medical treatment is not established. Carotid endarterectomy is confounded by the need to operate across scarred tissue planes, whereas carotid stenting procedures have resulted in high restenosis rates. CONCLUSIONS Head and neck radiotherapy significantly increases the risk of transient ischemic attack and ischemic stroke. Evidence-based guidelines for the management of asymptomatic and symptomatic (medium- and large-artery) radiation vasculopathy are lacking. Long-term prospective studies remain a priority, as the incidence of the problem is anticipated to rise with improvements in postradiotherapy patient survival.
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Affiliation(s)
- Chris Plummer
- Center for Neurosciences and Neurological Research, St Vincent's Hospital, Level 5 Daly Wing, 35 Victoria Parade, Fitzroy, Victoria, Australia, 3065.
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Tolentino GP, Battaglini CL, Araújo SS, Otano AS, Conde DM, Evans ES, de Oliveira RJ. Cardiorespiratory fitness and quality-of-life analysis posttreatment in breast cancer survivors. J Psychosoc Oncol 2010; 28:381-98. [PMID: 20623414 DOI: 10.1080/07347332.2010.484831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study compared VO(2peak), treatment frequency and dosage, and QOL between 22 post-treated breast cancer survivors (CATotal) and 22 apparently healthy, age-matched women (CO). The CATotal group included 11 with no history of any other co-morbidities (CA) and 11 with controlled hypertension (CA + H). VO(2peak) was measured using the Bruce Protocol. QOL was measured using the SF-36 survey. Significant differences were observed in VO(2peak) between CATotal and CO (p = 0.014), CA and CA + H (p = 0.001), and CA + H and CO (p = 0.001). Physical, emotional, and mental health domains of the SF-36 were significantly different between CATotal and CO (p = 0.006, 0.001, and 0.05 respectively). These results suggest that breast cancer survivors with controlled hypertension can experience a significant reduction in VO(2peak) when compared to apparently healthy, age-matched controls. Also, treatment frequency and dosage affected QOL in this group of survivors.
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Radiation to supraclavicular and internal mammary lymph nodes in breast cancer increases the risk of stroke. Br J Cancer 2009; 100:811-6. [PMID: 19259096 PMCID: PMC2653766 DOI: 10.1038/sj.bjc.6604902] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to assess whether adjuvant treatment of breast cancer (BC) affects the risk of stroke, and to explore radiation targets and fraction doses regarding risk and location of stroke. In a Swedish BC cohort diagnosed during 1970-2003, we carried out a nested case-control study of stroke after BC, with relevant details extracted from medical records. The odds ratio (OR) for radiotherapy (RT) vs that of no RT did not differ between cases and controls (OR=0.85; confidence interval, CI=0.6-1.3). Radiotherapy to internal mammary chain (IMC) and supraclavicular (SCL) lymph nodes vs that of no RT was associated with a higher, although not statistically significant, risk of stroke (OR=1.3; CI=0.8-2.2). In a pooled analysis, RT to IMC and SCL vs the pooled group of no RT and RT to breast/chest wall/axilla (but not IMC and SCL), showed a significant increase of stroke (OR=1.8; CI=1.1-2.8). There were no associations between cancer laterality, targets of RT, and location of stroke. The radiation targets, IMC and SCL, showed a statistically significant trend for an increased risk of stroke with daily fraction dose. Our finding of a target-specific increased risk of stroke and a dose-response relationship for daily fraction dose, indicate that there may be a causal link between RT to the IMC and SCL and risk of stroke.
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Scott AS, Parr LA, Johnstone PA. Risk of cerebrovascular events after neck and supraclavicular radiotherapy: A systematic review. Radiother Oncol 2009; 90:163-5. [DOI: 10.1016/j.radonc.2008.12.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 12/30/2008] [Accepted: 12/31/2008] [Indexed: 10/21/2022]
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Smith GL, Smith BD, Buchholz TA, Giordano SH, Garden AS, Woodward WA, Krumholz HM, Weber RS, Ang KK, Rosenthal DI. Cerebrovascular disease risk in older head and neck cancer patients after radiotherapy. J Clin Oncol 2008; 26:5119-25. [PMID: 18725647 PMCID: PMC4879715 DOI: 10.1200/jco.2008.16.6546] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Cerebrovascular disease is common in head and neck cancer patients, but it is unknown whether radiotherapy increases the cerebrovascular disease risk in this population. PATIENTS AND METHODS We identified 6,862 patients (age > 65 years) from the Surveillance, Epidemiology, and End Results (SEER) -Medicare cohort diagnosed with nonmetastatic head and neck cancer between 1992 and 2002. Using proportional hazards regression, we compared risk of cerebrovascular events (stroke, carotid revascularization, or stroke death) after treatment with radiotherapy alone, surgery plus radiotherapy, or surgery alone. To further validate whether treatment groups had equivalent baseline risk of vascular disease, we compared the risks of developing a control diagnosis, cardiac events (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, or cardiac death). Unlike cerebrovascular risk, no difference in cardiac risk was hypothesized. RESULTS Mean age was 76 +/- 7 years. Ten-year incidence of cerebrovascular events was 34% in patients treated with radiotherapy alone compared with 25% in patients treated with surgery plus radiotherapy and 26% in patients treated with surgery alone (P < .001). After adjusting for covariates, patients treated with radiotherapy alone had increased cerebrovascular risk compared with surgery plus radiotherapy (hazard ratio [HR] = 1.42; 95% CI, 1.14 to 1.77) and surgery alone (HR = 1.50; 95% CI, 1.18 to 1.90). However, no difference was found for surgery plus radiotherapy versus surgery alone (P = .60). As expected, patients treated with radiotherapy alone had no increased cardiac risk compared with the other treatment groups (P = .63 and P = .81). CONCLUSION Definitive radiotherapy for head and neck cancer, but not postoperative radiotherapy, was associated with excess cerebrovascular disease risk in older patients.
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Affiliation(s)
- Grace L. Smith
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Benjamin D. Smith
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Thomas A. Buchholz
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Sharon H. Giordano
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Adam S. Garden
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Wendy A. Woodward
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Harlan M. Krumholz
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Randal S. Weber
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - K.-Kian Ang
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - David I. Rosenthal
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Abstract
Cerebrovascular disorders, including brain infarction, brain hemorrhage, and cerebral venous thrombosis, can occur as an early sign of cancer, but typically occur late in the clinical course. These disorders are due to a variety of pathogenic mechanisms, including coagulation disorders associated with the cancer, invasion or compression of vessels from tumor in or adjacent to the brain, and the adverse effects of cancer therapy. The appropriate therapy for these cerebrovascular disorders is empiric in most instances, because as yet there are no prospective treatment trials for them. A review of the existing literature reveals that improvement in patient quality of life and prevention of further cerebrovascular events can be obtained in some clinical situations.
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Woodward WA, Durand JB, Tucker SL, Strom EA, Perkins GH, Oh J, Arriaga L, Domain D, Buchholz TA. Prospective analysis of carotid artery flow in breast cancer patients treated with supraclavicular irradiation 8 or more years previously: no increase in ipsilateral carotid stenosis after radiation noted. Cancer 2008; 112:268-73. [PMID: 18000801 DOI: 10.1002/cncr.23172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To the authors' knowledge, the effects of supraclavicular fossa radiation on the carotid artery are not well described. In the current study, the authors performed a prospective study to examine the long-term risk of carotid artery stenosis after supraclavicular irradiation for breast cancer. METHODS A total of 46 breast cancer patients who were treated with adjuvant radiation to the supraclavicular fossa with >8 years of follow-up underwent bilateral Doppler imaging of the carotid artery. Two independent cardiologists interpreted each ultrasound study with no knowledge of which side was treated. RESULTS The median follow-up from the date of diagnosis was 14.6 years and the mean patient age at the time of ultrasound was 55 years. The median prescribed dose to the supraclavicular fossa was 50 grays. Four patients were found to have clinically relevant, asymptomatic carotid stenosis, for which a cardiology referral was necessary. Only 1 of these 4 patients had stenosis involving the irradiated carotid artery only; 1 patient had bilateral stenosis and 2 patients had only contralateral stenosis. There was no difference noted with regard to isolated ipsilateral versus contralateral medial intimal thickening of the carotid artery (5 patients vs 6 patients, respectively). Furthermore, there were no differences noted with regard to ipsilateral versus contralateral peak systolic flow in the internal (83.5 vs 85.6 cm/seconds; P= .522 by the Student t test and P= .871 by the signed rank test) or common (74.4 vs 77.0 cm/seconds; P= .462 by the Student t test and P= .246 by the signed rank test) carotid artery. CONCLUSIONS In this prospective study of breast cancer patients with long follow-up, there was no evidence of late, clinically relevant stenosis, increased intimal thickening, or increased peak systolic carotid artery flow secondary to supraclavicular irradiation.
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Affiliation(s)
- Wendy A Woodward
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Senkus-Konefka E, Jassem J. Cardiovascular effects of breast cancer radiotherapy. Cancer Treat Rev 2007; 33:578-93. [PMID: 17764850 DOI: 10.1016/j.ctrv.2007.07.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 07/13/2007] [Accepted: 07/16/2007] [Indexed: 10/22/2022]
Abstract
Cardiac toxicity has been implicated as the primary reason for excess non-breast cancer mortality in early breast cancer radiotherapy studies. Refinements in radiotherapy techniques have allowed for a considerable reduction of this risk in the majority of breast cancer patients. Recent large population-based studies confirmed an increase of cardiovascular death risk in patients irradiated for cancer of the left breast and in individuals exposed to relatively low (hitherto believed to be of no cardiovascular disease risk) doses of radiation, such as atomic bomb survivors or patients treated for various benign conditions. The issue of potential radiation-related cardiac damage may also be assuming a new significance due to the widespread use of other cardiotoxic agents, such as anthracyclines, paclitaxel and trastuzumab. The aim of this review is to summarize and critically analyze the available evidence on the impact of ionizing radiation on the cardiovascular system, with special attention to recent data demonstrating previously unrecognized adverse effects. This review discusses the pathology of radiation-related cardiovascular disease, its clinical presentation, risk factors and methods of assessment, as well as technical developments minimizing cardiac exposure. Epidemiological data are presented on the incidence of radiation-induced heart disease and cardiovascular mortality in various populations of patients irradiated for breast cancer and in individuals exposed to low radiation doses. Additionally, non-cardiac radiation-related vascular morbidity and mortality in breast cancer patients are addressed.
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Affiliation(s)
- Elzbieta Senkus-Konefka
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Debinki 7, 80-211 Gdańsk, Poland.
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