Reduced increase of calcium scores using breath-hold in left-sided whole breast irradiation

• Published in: Radiotherapy and oncology Vol. 149; pp. 78 - 83
• Main Authors: Mast, M.E., Pekelharing, J.F., Heijenbrok, M.W., van Klaveren, D., van Kempen-Harteveld, M.L., Petoukhova, A.L., Verbeek-de Kanter, A., Schreur, J.H.M., Struikmans, H.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-08-2020
• Subjects: Breast cancer; Breast Neoplasms - radiotherapy; Breath Holding; Calcium; Coronary arteries; Coronary artery calcium scores; Heart; Humans; Longitudinal Studies; Prospective Studies; Radiotherapy Dosage; Coronary artery calcium scores; Breast cancer; Coronary arteries
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2020.05.001

•We found a significant attenuation of calcium scores in time using breath-hold.•This effect was even higher in patients with calcium scores > 0 at baseline.•This effect became more pronounced after longer follow-up.
In this prospective longitudinal study, Coronary Artery Calcium (CAC) scores determined before the start of whole breast irradiation were compared with those determined 7 years afterwards. The aim was to examine whether the use of a breath-hold (BH) technique is associated with less increase of CAC scores.
Changes in CAC scores were analysed in 87 breast cancer patients. The results of the following groups were compared: patients receiving right (R) or left-sided radiotherapy using free breathing (L-FB) with those receiving left-sided radiotherapy with BH (L-BH). We compared the changes of CAC scores between these groups over time, testing the hypothesis that a significantly reduced increase of calcium scores is observed when using BH.
For L-BH cases, when compared with L-FB cases, for overall as well as for Left Anterior Descending coronary artery (LAD) CAC scores, we noted significantly less increased CAC scores (p < 0.01). This effect of BH was even more striking in the group with CAC scores >0 at baseline. The attenuated increase over time of CAC scores in the L-BH group was robust to correction for age and statin use (p < 0.05).
After a median follow-up of 7.4 years, we found significantly less increased CAC scores when using BH. This is a relevant finding since higher levels of CAC scores are associated with higher probabilities of coronary artery events. Moreover, it underlines the rationale for the use of BH in left-sided whole breast irradiation.