Long-term cardiovascular mortality after radiotherapy for breast cancer: A systematic review and meta-analysis
Department of Medicine
Cardiology | Neoplasms
BACKGROUND: Radiotherapy (RT) is frequently associated with late cardiovascular (CV) complications. The mean cardiac dose from irradiation of a left-sided breast cancer is much higher than that for a right-sided breast cancer. However, data is limited on the long-term risks of RT on CV mortality.
HYPOTHESIS: RT for breast cancer is associated with long term CV mortality and left sided RT carries a greater mortality than right sided RT.
METHODS: We searched PubMed, Cochrane Central, Embase, EBSCO, Web of Science, and CINAHL databases from inception through December 2015. Studies reporting CV mortality with RT for left- vs right-sided breast cancers were included. The principal outcome of interest was CV mortality. We calculated summary risk ratio (RR) and 95% confidence intervals (CI) with the random-effects model.
RESULTS: The analysis included 289 109 patients from 13 observational studies. Women who had received RT for left-sided breast cancer had a higher risk of CV death than those who received RT for a right-sided breast cancer (RR: 1.12, 95% CI: 1.07-1.18, P < 0.001; number needed to harm: 353). Difference in CV mortality between left- vs right-sided breast RT was more apparent after 15 years of follow-up (RR: 1.23, 95% CI: 1.08-1.41, P < 0.001; number needed to harm: 95).
CONCLUSIONS: CV mortality from left-sided RT was significantly higher compared with right-sided RT for breast cancer and was more apparent after > /=15 years of follow-up.
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Citation: Clin Cardiol. 2017 Feb;40(2):73-81. doi: 10.1002/clc.22631. Epub 2016 Nov 2. Link to article on publisher's site
DOI of Published Version
Breast Cancer, Cardiovascular Mortality, Radiotherapy
Sardar, Partha; Kundu, Amartya; Chatterjee, Saurav; Nohria, Anju; Nairooz, Ramez; Bangalore, Sripal; Mukherjee, Debabrata; Aronow, Wilbert S.; and Lavie, Carl J., "Long-term cardiovascular mortality after radiotherapy for breast cancer: A systematic review and meta-analysis" (2017). Open Access Articles. 2973.