{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:47:55Z","timestamp":1790030875138,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We assess the relationship between radiation dose to the heart and cardiac disease within the context of modern radiotherapy techniques of 3\u2010dimensional and intensity\u2010modulated radiotherapy (IMRT). The KROG 15\u201003 study was a multicenter phase III trial involving 693 breast cancer patients who underwent breast\u2010conserving surgery (BCS). Patients were randomly assigned to receive either IMRT or 3D\u2010CRT following BCS. Major cardiac event (MCE), defined as the occurrence of angina pectoris or myocardial infarction requiring coronary angiography, and admission for cardiac arrhythmia related to the irradiation of the heart. The primary outcome of the study was to investigate the incidence of MCE and factors associated with MCEs. At a median follow\u2010up of 6.5\u2009years, the incidence of MCEs at 6.5\u2009years was 1.8%. The mean heart dose (MHD) for the entire cohort of 647 patients was 2.1 (\u00b12.3) Gy. The cumulative incidence of MCEs at 6.5\u2009years was 1.1% for the subgroup of MHD &lt;2.9\u2009Gy and 3.3% for the subgroup of MHD &gt;2.9\u2009Gy (<jats:italic>p<\/jats:italic>\u2009=\u20090.010), and 0.9% for the subgroup of age \u226455\u2009years and 3.3% for the subgroup of age &gt;55\u2009years (<jats:italic>p<\/jats:italic>\u2009=\u20090.006), respectively. Multivariate analyses confirmed that MHD (<jats:italic>p<\/jats:italic>\u2009=\u20090.044; hazard ratio [HR], 1.21 per 1\u2009Gy; 95% confidence interval [CI], 1.09\u20131.46) and age (<jats:italic>p<\/jats:italic>\u2009=\u20090.034; HR, 1.07 per 1\u2009year; 95% CI, 1.03\u20131.14) were significant factors of MCEs. The incidence of MCE increased by 21% per 1\u2010Gy increase in MHD within 6.5\u2009years after radiotherapy.<\/jats:p>","DOI":"10.1002\/ijc.35476","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T21:14:06Z","timestamp":1746825246000},"page":"1395-1404","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Long\u2010term risk of major cardiac events in breast cancer patients treated with intensity\u2010modulated and 3\u2010dimensional conformal radiotherapy: Secondary analysis of a randomized clinical trial"],"prefix":"10.1002","volume":"157","author":[{"given":"Nam Kyu","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology St. Vincent's Hospital, College of Medicine, The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyu Hye","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Uk","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Chonnam National University Hospital, Chonnam National University School of Medicine  Gwangju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Ja","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Chonnam National University Hospital, Chonnam National University School of Medicine  Gwangju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Dongsan Medical Center, Keimyung University School of Medicine  Daegu Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bae Kwon","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Gyeongsang National University Hospital, Gyeongsang National University School of Medicine  Jinju Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Byul","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology St. Vincent's Hospital, College of Medicine, The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo 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