From heart to heart for breast cancer patients—cardiovascular toxicities in breast cancer radiotherapy

Excerpt

A recent paper by Darby et al. [1] on heart toxicities after radiotherapy of breast cancer generated a strong debate in the medical and nonmedical press [2]. In the modern era of 3D conformal radiation oncology, few of us have seen patients with heart toxicities, but does this mean that the topic is obsolete? The paper by Darby et al. [1] is a landmark in this field of clinical research. It is a large and very carefully designed case–control study on radiation-induced major coronary events (i.e., myocardial infarction, coronary stenting, or death from ischemic heart disease) after postoperative radiotherapy of breast cancer. By using a case–control design, the authors reduced the influence of changing treatment concepts and techniques of radiation treatment over time. Furthermore, the study not only analyzed death from coronary events, but incidence of any major coronary event. In the modern era of cardiology and radiation oncology, minimizing the risk of coronary events for every age should be our next goal [3, 4]. Therefore, the study deserves careful and critical evaluation. Based on our experience as the coordinator of the European research project CARDIORISK [5, 6], we see the need to discuss the clinical relevance of the data in greater depth. …