Cardiac Risk After Heart-Sparing Breast Radiotherapy

In patients with breast cancer treated with contemporary heart-sparing breast radiotherapy, is radiation dose to the left anterior descending coronary artery (LAD) associated with more long-term adverse cardiac events compared with conventional whole-heart dose metrics?This cross-sectional study of 4908 patients with breast cancer (2223 left-sided) found that higher maximum LAD dose had a statistically significant independent association with increased risk of cardiac events, whereas the whole-heart dose did not.These findings suggest that LAD-specific dosimetry may better identify cardiac risk than whole-heart metrics in modern breast radiotherapy, and supports incorporating LAD objectives into plan quality evaluation.

Corresponding Author: Michael Roumeliotis, PhD, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21287 (mroumel1@jhu.edu); and Sarah Quirk, PhD, Department of Radiation Oncology, Mass General Brigham Cancer Institute and Harvard Medical School, 75 Francis St, Boston, Massachusetts (squirk2@bwh.harvard.edu).

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