Communication Dans Un Congrès Année : 2023

Early Development of Atherosclerotic Plaques in the Coronary Arteries after Radiotherapy for Breast Cancer (BACCARAT Study)

Résumé

Introduction Radiotherapy (RT) for breast cancer (BC) can lead to an increased risk of coronary artery disease several years after RT. Long before the eventual occurrence of coronary radiation disease, a precise evaluation of calcified and non-calcified atheromatous plaques, quantifiable by coronary CT scan, could allow a better understanding of the early phases of radiation-induced atherosclerosis and the possible implementation of preventive measures. Objective The aim of this study was to evaluate the development of overall, non-calcified and calcified atherosclerotic plaques over 2 years after RT for BC and associations with cardiac exposure. Method This study included BC patients treated with 3D-CRT without chemotherapy or a history of cardiovascular disease. A contrast-enhanced coronary CT scan was performed before RT and then 2 years after RT. Plaque progression was defined at the individual level for patients with an increased number of plaques at 2-year follow-up. Dosimetric data were collected for the total heart, left ventricle, and each coronary artery (left main: LM, left anterior descending: LAD, circumflex: CX, right coronary: RC). Logistic regression models were used to assess the association between doses and risk of plaque progression with odds ratios (OR) and 95% confidence intervals (CI). This study included 101 patients (84 left and 17 right BC). Results The mean age at inclusion was 58.4 years. The majority of patients were free of atherosclerotic plaque at baseline and at 2-year follow-up (63% and 58%, respectively). Two years after RT, 7 patients (100% left breast) showed plaque progression: for 6 patients this progression was observed in the LAD, the most highly exposed coronary artery (Dmean = 16.0 Gy), and for 1 patient in the RC. Progression of calcified and noncalcified plaques was observed in 5 and 4 patients, respectively. The analysis of associations between dose and risk of plaque progression showed statistically significant association only for doses to the LM and CX (OR = 2.32 IC95%: 1.08–4.97; P = 0.03) and (OR = 2.27 IC95%: 1.09–4.74; P = 0.03) and positive but not significant for the other structures. Conclusion Our study suggests an association between the exposure of certain coronary arteries and the risk of an increase in the number of atherosclerotic plaques 2 years after breast cancer RT, whether calcified or not. These results remain to be confirmed, however, given the very limited number of patients, further research is needed to improve the understanding of the early mechanisms of radiation-induced atherosclerosis.

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Dates et versions

hal-05236034 , version 1 (02-09-2025)

Identifiants

Citer

M.K.F. Honaryar, Rodrigue S. Allodji, Gaëlle Jimenez, M. Lapeyre, Loïc Panh, et al.. Early Development of Atherosclerotic Plaques in the Coronary Arteries after Radiotherapy for Breast Cancer (BACCARAT Study). JESFC 2024 - 34èmes Journées Européennes de la Société Française de Cardiologie, SFC – Société Française de Cardiologie, Jan 2024, Paris, France. ⟨10.1016/j.acvd.2023.10.200⟩. ⟨hal-05236034⟩
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