Estimating the risk of major adverse cardiac events following radiotherapy for left breast cancer using a modified generalized Lyman normal-tissue complication probability model
Tzu-Yu Lai,
Yu-Wen Hu,
Ti-Hao Wang,
Jui-Pin Chen,
Cheng-Ying Shiau,
Pin-I Huang,
I-Chun Lai,
Yu-Ming Liu,
Chi-Cheng Huang,
Ling-Ming Tseng,
Nicole Huang,
Chia-Jen Liu
Affiliations
Tzu-Yu Lai
Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
Yu-Wen Hu
Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
Ti-Hao Wang
Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan, R.O.C; Department of Medicine, China Medical University, Taichung, Taiwan, R.O.C; Everfortune.AI, Taichung, Taiwan, R.O.C
Jui-Pin Chen
Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
Cheng-Ying Shiau
Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
Pin-I Huang
Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
I-Chun Lai
Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
Yu-Ming Liu
Department of Heavy Particles & Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
Chi-Cheng Huang
Comprehensive Breast Health Center & Division of Breast Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C
Ling-Ming Tseng
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C; Comprehensive Breast Health Center & Division of Breast Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
Nicole Huang
Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
Chia-Jen Liu
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C; Corresponding author. Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan, 11217, R.O.C.
Background: We introduced an adapted Lyman normal-tissue complication probability (NTCP) model, incorporating clinical risk factors and censored time-to-event data, to estimate the risk of major adverse cardiac events (MACE) following left breast cancer radiotherapy (RT). Materials and methods: Clinical characteristics and MACE data of 1100 women with left-side breast cancer receiving postoperative RT from 2005 to 2017 were retrospectively collected. A modified generalized Lyman NTCP model based on the individual left ventricle (LV) equivalent uniform dose (EUD), accounting for clinical risk factors and censored data, was developed using maximum likelihood estimation. Subgroup analysis was performed for low-comorbidity and high-comorbidity groups. Results: Over a median follow-up 7.8 years, 64 patients experienced MACE, with higher mean LV dose in affected individuals (4.1 Gy vs. 2.9 Gy). The full model accounting for clinical factors identified D50 = 43.3 Gy, m = 0.59, and n = 0.78 as the best-fit parameters. The threshold dose causing a 50 % probability of MACE was lower in the high-comorbidity group (D50 = 30 Gy) compared to the low-comorbidity group (D50 = 45 Gy). Predictions indicated that restricting LV EUD below 5 Gy yielded a 10-year relative MACE risk less than 1.3 and 1.5 for high-comorbidity and low-comorbidity groups, respectively. Conclusion: Patients with comorbidities are more susceptible to cardiac events following breast RT. The proposed modified generalized Lyman model considers nondosimetric risk factors and addresses incomplete follow-up for late complications, offering comprehensive and individualized MACE risk estimates post-RT.
