Cardiac toxicity following radiotherapy in breast cancer patients
Cardiac toxicity following radiotherapy in breast cancer patients
Breast cancer is the most common cancer in women. More women survive it, partly because radiotherapy lowers the chance it comes back. But the heart receives some of that radiation too, which can cause heart problems years later. This research of Daan Spoor asked how large that risk is, who is most at risk, and how to detect damage early.
We compared more than 1,300 women treated for breast cancer with 5,300 women of the same age who never had cancer. They were healthier on familiar risk factors such as blood pressure, and yet heart failure was more common among them. That suggests the treatment itself plays a part.
We then improved how precisely we can measure the dose reaching each individual part of the heart. With that, we built models predicting heart attacks in the ten years after treatment. Above all, it was the combination of a high dose to the heart and calcium build-up in the heart's own arteries that raised this risk.
MRI scans also picked up early signs of heart damage, before any symptoms: in roughly one in six women the heart pumped slightly less strongly two years after radiotherapy, more often at a higher dose. Such measurements reveal which parts of the heart are most vulnerable.
Treatment can then be made more personal: spreading the dose to spare vulnerable parts of the heart, proton therapy for the women who gain most from it, and targeted follow-up for those at risk, so problems are treated early or even prevented.