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Eur J Cancer. 2014 Sep;50(13):2201-10. doi: 10.1016/j.ejca.2014.04.033. Epub 2014 Jun 18.

Increased cardio and cerebrovascular mortality in breast cancer patients treated with postmastectomy radiotherapy--25 year follow-up of a randomised trial from the South Sweden Breast Cancer Group.

Author information

1
Skåne Department of Oncology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden. Electronic address: Fredrika.Killander@med.lu.se.
2
Department of Cancer Epidemiology, Lund University, Lund, Sweden.
3
Skåne Department of Oncology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden.

Abstract

AIM OF THE STUDY:

To analyse late morbidity and mortality in pre and post-menopausal breast cancer patients treated with postmastectomy radiotherapy, with emphasis on side-effects from the heart, cerebrovascular and respiratory systems.

METHODS:

Long term follow-up of two randomised, clinical trials with 1100 patients was carried out. Pre-menopausal women were allocated to radiotherapy (RT), RT+oral cyclophosphamide (RT+C) or cyclophosphamide only (C). Post-menopausal women were allocated to RT, RT+Tamoxifen for one year (RT+Tam) or tamoxifen only (Tam). Information on admission to hospital, mortality and causes of death was obtained from national registers.

RESULTS:

After 25 years, adding RT to cyclophosphamide in pre-menopausal women raised the mortality from heart disease from zero to 0.8% (p=0.04). In post-menopausal women, adding RT to Tam raised the mortality from heart disease from 10.5% to 18.4% (p=0.005). In post-menopausal women mortality due to cerebrovascular disease increased from 3.4% to 8.7% by adding RT to Tam (p=0.015). The differences were not evident until in the second decade of follow-up. In spite of differences in specific causes of death, there were no significant differences between the treatment arms concerning morbidity or overall mortality.

CONCLUSION:

Postmastectomy radiotherapy to the chest wall and loco-regional lymph nodes including the parasternal lymph nodes as delivered in the end of the seventies did not reduce overall mortality, but gave a significantly increased risk of death from heart and cerebrovascular disease, which appeared during the second decade after radiotherapy.

KEYWORDS:

Breast cancer; Cause of death; Cerebrovascular disease; Heart disease; Radiotherapy; Side-effect

PMID:
24951164
DOI:
10.1016/j.ejca.2014.04.033
[Indexed for MEDLINE]

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