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Coronary Artery Findings After Left-Sided Compared With Right-Sided Radiation Treatment for Early-Stage Breast Cancer

Candace R. Correa, Harold I. Litt, Wei-Ting Hwang, Victor A. Ferrari, Lawrence J. Solin, Eleanor E. Harris

From the Department of Radiation Oncology, Radiology-Cardiovascular Imaging Section, Medicine-Division of Cardiovascular Medicine, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA

Address reprint requests to Candace R. Correa, MD, Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr, UH B2C490, Box 0010, Ann Arbor, MI 48109; e-mail: ccorrea{at}mail.med.umich.edu

Purpose To compare the incidence and distribution of coronary artery disease after left-sided versus right-sided irradiation in patients treated with breast conservation for early-stage breast cancer who subsequently underwent cardiac stress testing and/or catheterization for cardiovascular symptoms.

Patients and Methods The medical records of 961 stage I-II breast cancer patients treated from 1977 to 1995 at the University of Pennsylvania with conventional tangential beam radiation treatment (RT) were screened for cardiac stress tests and catheterizations performed after RT. The results of these tests were analyzed by laterality of RT and compared with baseline cardiovascular risk.

Results At diagnosis, patients with left-sided and right-sided breast cancer had the same estimated 10-year risk (both 7%) of developing coronary artery disease. At a median time of 12 years post-RT (range, 2 to 24 years), 46 patients with left-sided and 36 patients with right-sided breast cancer (total, N = 82) had undergone cardiac stress testing. A statistically significant higher prevalence of stress test abnormalities was found among left (27 of 46; 59%) versus right-side irradiated patients (three of 36; 8%; P = .001). Furthermore, 19 of 27 of left-sided abnormalities (70%) were in the left anterior descending artery territory. Thirteen left-side irradiated patients also underwent cardiac catheterization revealing 12 of 13 with coronary stenoses (92%) and eight of 13 with coronary stenoses (62%) solely in the left anterior descending artery.

Conclusion Patients treated with left-sided radiation as a component of breast conservation have an increased risk of late, radiation-associated coronary damage. Treatment with modern radiation techniques may reduce the risk of cardiac injury.

Supported by a grant from the Breast Cancer Research Foundation.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, New Orleans, LA, June 5-8, 2004.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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• Coronary Artery Disease After Radiation Therapy for Early Breast Cancer
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