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Less increase of CT-based calcium scores of the coronary arteries

Effect three years after breast-conserving radiotherapy using breath-hold

Geringe Zunahme CT-basierter Kalziumwerte der Koronararterien

Wirkung drei Jahre nach brusterhaltender Radiotherapie unter Atemanhalt

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Abstract

Purpose

The aim of this prospective longitudinal study was to compare coronary artery calcium (CAC) scores determined before the start of whole breast irradiation with those determined 3 years afterwards.

Patients and methods

Changes in CAC scores were analysed in 99 breast cancer patients. Three groups were compared: patients receiving left- and right-sided radiotherapy, and those receiving left-sided radiotherapy with breath-hold. We analysed overall CAC scores and left anterior descending (LAD) and right coronary artery (RCA) CAC scores. Between the three groups, changes of the value of the LAD minus the RCA CAC scores of each individual patient were also compared.

Results

Three years after breath-hold-based whole breast irradiation, a less pronounced increase of CAC scores was noted. Furthermore, LAD minus RCA scores in patients treated for left-sided breast cancer without breath-hold were higher when compared to LAD minus RCA scores of patients with right-sided breast cancers and those with left-sided breast cancer treated with breath-hold.

Conclusion

Breath-hold in breast-conserving radiotherapy leads to a less pronounced increase of CT-based CAC scores. Therefore, breath-hold probably prevents the development of radiation-induced coronary artery disease. However, the sample size of this study is limited and the follow-up period relatively short.

Zusammenfassung

Ziel

Das Ziel dieser prospektiven Langzeitstudie war der Vergleich der Coronary-Artery-Calcium-(CAC-)Werte vor Beginn der Brustbestrahlung mit den Werten nach 3 Jahren.

Patienten und Methoden

Änderungen der CAC-Werte wurden bei 99 Brustkrebspatienten analysiert. Drei Gruppen wurden untersucht: Patienten nach links- und rechtsseitiger Strahlentherapie sowie mit Bestrahlung unter Atemanhalt. Wir analysierten die Gesamt-CAC-Werte sowie die CAC-Werte der vorderen linken absteigenden („left anterior descending“, LAD) und der rechten Koronararterie („right coronary artery“, RCA). Zwischen den drei Gruppen wurden auch die Veränderungen der CAC-Werte der LAD minus der RCA-Werte für jeden einzelnen Patienten verglichen.

Ergebnisse

Drei Jahre nach Brustbestrahlung mit Atemanhalt wurde eine gering ausgeprägte Erhöhung der CAC-Werte zur Kenntnis genommen. Patienten mit linksseitigem Brustkrebs, die ohne Atemanhalt behandelt wurden, hatten einen höheren LAD-minus-RCA-Wert als Patienten mit rechtsseitigem Brustkrebs und als jene mit linksseitigem Brustkrebs mit Atemanhalt.

Schlussfolgerung

Atemanhalt zusammen mit einer brusterhaltenden Radiotherapie führt zu einem geringen Anstieg der CT-basierten CAC-Werte. Bestrahlungen unter Atemanhalt verhindern wahrscheinlich die Entwicklung von strahlungsinduzierten Krankheiten der Koronararterien. Allerdings ist die Stichprobengröße dieser Studie begrenzt und die Follow-up-Periode relativ kurz.

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Acknowledgements

We thank the patients for participating in this study; the radiation oncologists: J. Biesta, H. Ceha, H. De Jager, P. Koper, T. Stam, S. Swank-Bordewijk, A. Verbeek-de Kanter, R. Wiggenraad for including patients in this study; the medical receptionists for arranging the appointments for the calcium CT scans; colleagues of the radiology department in MCH Antoniushove for arranging and performing the calcium CT scans; I. Korteland for processing the letters to the general practitioners and the patients; J. van Egmond for creating the Access database and his assistance with Excel; T.F.H. Vissers for bibliographical assistance; and J.F.D. Bouricius for critically editing this article.

Author information

Authors and Affiliations

  1. Radiotherapy, Centre West, Lijnbaan 32, 2501 CK, The Hague, The Netherlands

    M. E. Mast PhD, M. L. van Kempen-Harteveld MD PhD, A. L. Petoukhova PhD & H. Struikmans MD PhD

  2. Department of radiology, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands

    M. W. Heijenbrok MD

  3. Department of Radiation Oncology, Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    A. N. Scholten MD PhD

  4. Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands

    R. Wolterbeek

  5. Department of Cardiology, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands

    J. H. M. Schreur MD PhD

  6. Department of Clinical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands

    H. Struikmans MD PhD

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  1. M. E. Mast PhD
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Correspondence to M. E. Mast PhD.

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Conflict of interest

M. E. Mast, M. W. Heijenbrok, M. L. van Kempen-Harteveld, A.L. Petoukhova, A. N. Scholten, R. Wolterbeek, J. H. M. Schreur, and H. Struikmans state that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Mast, M.E., Heijenbrok, M.W., van Kempen-Harteveld, M.L. et al. Less increase of CT-based calcium scores of the coronary arteries. Strahlenther Onkol 192, 696–704 (2016). https://doi.org/10.1007/s00066-016-1026-4

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