Evidence map›Paper›PMID 23484825›Full record

ArticleThe New England journal of medicine2013

Risk of ischemic heart disease in women after radiotherapy for breast cancer.

Sarah C Darby, Marianne Ewertz, Paul McGale, Anna M Bennet, Ulla Blom-Goldman, Dorthe Brønnum, Candace Correa, David Cutter, Giovanna Gagliardi, Bruna Gigante and 6 more

8 registry-linked trialsAbstract read
PubMed Publisher
In one paragraph

Article in The New England journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 8 registered trials, which are not on this map. Cited by 1,790 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1,790citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03037723 nacompletednot on this map

Prospective Trial of Prone Whole-Breast RadiationTherapy Versus Supine Whole-Breast Radiation Therapy With and Without Respiratory Gating, a Dosimetric Comparison

TypeinterventionalSponsorState University of New York - Upstate Medical UniversityRan2013 to 2020Enrolled150ConditionsBreast Cancer, Respiratory Gating, ProneArmsCT simulation
NCT03235427 completednot on this mapstarted 2017, after this paper: background citation

The CAROLE (CArdiac Related Oncologic Late Effects) Study

TypeobservationalSponsorNorthwell HealthRan2017 to 2018Enrolled201ConditionsCoronary Artery Disease, Cardiac Disease, Cardiac Toxicity, Radiation
NCT03511781 nacompletednot on this mapstarted 2015, after this paper: background citation

Hypofractionated Radiotherapy Schedule of 35 Gray in 10 Fractions in Advanced Incurable Breast Cancer: A Prospective Phase I/II Study

TypeinterventionalSponsorTata Medical CenterRan2015 to 2021Enrolled30ConditionsCarcinoma Breast Stage IVArmsHypofractionated Radiotherapy
NCT03534570 unknown statusnot on this mapstarted 2018, after this paper: background citation

A Prospective Study on the Need of Gated (GAT) Radiotherapy in Left Sided Breast Cancer Patients Treated at the Technical University Munich (TUM) - the GATTUM Protocol

TypeobservationalSponsorTechnical University of MunichRan2018 to 2019Enrolled150ConditionsBreast Neoplasm Female, Radiotherapy Side Effect, Heart Diseases
NCT05081115 recruitingnot on this mapstarted 2021, after this paper: background citation

The International Stress Echo Study to to Define the Future of Imaging

Typeobservational_patient_registrySponsorFatebenefratelli HospitalRan2021 to 2030Enrolled10,000ConditionsCoronary Artery Disease, Heart Failure, Hypertrophic Cardiomyopathy, Congenital Heart DiseaseArmsABCDE-Stress Echo, SE diastolic assessment, SE Right ventricular function assessment, SE in heart donors
NCT05454553 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Efficacity of Deep Inspiration Breath Hold and Intensity-modulated Radiotherapy in Preventing PErfusion Defect for Left Sided Breast Cancer (EDIPE)

TypeinterventionalSponsorInstitut de cancérologie Strasbourg EuropeRan2022 to 2024Enrolled58ConditionsBreast CancerArmsmyocardial perfusion SPECT
NCT06100068 nacompletednot on this mapstarted 2023, after this paper: background citation

Hyperventilation and Oxygenation to Increase Breath Hold in Breast Cancer Irradiation Treatment (HOBBIT) 3: Mental Exercises and Temporal Alteration

TypeinterventionalSponsorUniversity Hospital, GhentRan2023 to 2025Enrolled36ConditionsBreast Neoplasm, Radiotherapy, Breath Holding, Mental TestArmsMental Exercises and Temporal Alteration
NCT06946238 narecruitingnot on this mapstarted 2025, after this paper: background citation

Accelerated Partial Breast Irradiation in One Fraction for Patients With Early-stage Disease and Favorable Histological Subtypes (Breast-1F).

TypeinterventionalSponsorIRCCS San RaffaeleRan2025 to 2035Enrolled311ConditionsBreast CancerArmsAdjuvant single-fraction accelerated partial breast irradiation
3 · Its place in the literature

Who cites it

1,790 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
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  14. Prolonging breath-hold duration in radiotherapy using cognitive engagement.Clinical and translational radiation oncology · 2027
    Article
  15. Article
  16. Article
  17. Review
  18. Article
  19. Radiation-induced AXL upregulation in CCR2Clinical and translational medicine · 2026
    Article
  20. Article

1,730 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors.

Sarah C DarbyClinical Trial Service Unit, University of Oxford, Oxford, United Kingdom. sarah.darby@ctsu.ox.ac.uk
Marianne Ewertz
Paul McGale
Anna M Bennet
Ulla Blom-Goldman
Dorthe Brønnum
Candace Correa
David Cutter
Giovanna Gagliardi
Bruna Gigante
Maj-Britt Jensen
Andrew Nisbet
Richard Peto
Kazem Rahimi
Carolyn Taylor
Per Hall

Funding

British Heart Foundation CRE RE/08/004Cancer Research UKDepartment of Health RRX 108Medical Research Council MC_U137686858
6 · The paper itself

Abstract

backgroundRadiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of ischemic heart disease is uncertain.

methodsWe conducted a population-based case-control study of major coronary events (i.e., myocardial infarction, coronary revascularization, or death from ischemic heart disease) in 2168 women who underwent radiotherapy for breast cancer between 1958 and 2001 in Sweden and Denmark; the study included 963 women with major coronary events and 1205 controls. Individual patient information was obtained from hospital records. For each woman, the mean radiation doses to the whole heart and to the left anterior descending coronary artery were estimated from her radiotherapy chart.

resultsThe overall average of the mean doses to the whole heart was 4.9 Gy (range, 0.03 to 27.72). Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P<0.001), with no apparent threshold. The increase started within the first 5 years after radiotherapy and continued into the third decade after radiotherapy. The proportional increase in the rate of major coronary events per gray was similar in women with and women without cardiac risk factors at the time of radiotherapy.

conclusionsExposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women. (Funded by Cancer Research UK and others.).

Indexed as

AdultAgedBreast NeoplasmsCase-Control StudiesChemotherapy, AdjuvantFemaleHeartHumansMastectomyMiddle AgedMyocardial IschemiaRadiation InjuriesRadiotherapy, AdjuvantRadiotherapy DosageRiskRisk Factors

Identifiers

PMID23484825

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

and 2 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.