Journal Article Epublish
PubMed: 42290894 DOI: 10.1016/j.ctro.2026.101213
Longitudinal changes in NT-proBNP after breast cancer radiotherapy: clinical determinants of its trajectory and association with cardiac dysfunction (BACCARAT study).
Clin Transl Radiat Oncol 60:101213
Authors: Médéa Locquet, Gaëlle Jimenez, Jérémy Camilleri, David Broggio, Olivier Lairez, Loïc Panh, Georges Tarlet, Jean Ferrières, Fabien Milliat, Sophie Jacob
Affiliations
- Public Health Aging Research and Epidemiology (PHARE) Group, Research Unit in Clinical Pharmacology and Toxicology (URPC), Department of Biomedical Sciences, NAmur Research Institute for LIfe Sciences (NARILIS), Faculty of Medicine, University of Namur, Namur, Belgium.
- Department of Radiation Oncology (Orion), Clinique Pasteur, Toulouse, France.
- PSE-SANTE/SDOS, Department of Dosimetry, Authority for Nuclear Safety and Radiation Protection (ASNR), Fontenay-aux-Roses, France.
- Department of Cardiology, Toulouse University Hospital, Toulouse, France.
- Medical School, Toulouse III Paul Sabatier University, Toulouse, France.
- Department of Cardiology, Clinique Pasteur, Toulouse, France.
- PSE-SANTE/SERAMED/LRMed, Laboratory of Radiobiology of Medical Exposures, Authority for Nuclear Safety and Radiation Protection (ASNR), Fontenay-aux-Roses, France.
- National Institute for Medical Research (Inserm), UMR 1295 (CERPOP), Toulouse 31400, France.
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.
- PSE-SANTE/SESANE/LEPID, Laboratory of Epidemiology, Authority for Nuclear Safety and Radiation Protection (ASNR), Fontenay-aux-Roses, France.
Abstract
BACKGROUND AND PURPOSE
Radiotherapy (RT) for breast cancer (BC) may induce subclinical myocardial injury. Longitudinal trajectories of N-terminal pro-B-type natriuretic peptide (NT-proBNP), a biomarker of myocardial stress, remain insufficiently characterized. We aimed to assess changes in NT-proBNP over 2 years after RT, identify clinical and treatment-associated factors, and evaluate associations with cancer therapy-related cardiac dysfunction (CTRCD).
METHODS
NT-proBNP was measured before RT, at RT completion, and at 6 and 24 months among 101 BC patients treated with adjuvant RT without chemotherapy. Echocardiography was performed longitudinally, and CTRCD was defined according to 2022 ESC Cardio-Oncology guidelines. Factors associated with NT-proBNP trajectories were analyzed using linear mixed-effects models. Logistic regression assessed associations between NT-proBNP and CTRCD.
RESULTS
NT-proBNP remained stable at the end of RT and at 6 months but increased at 24 months (β = 0.147, p < 0.0001; +16%). Baseline NT-proBNP was strongly associated with follow-up levels. Hypercholesterolemia (β = 0.252, p = 0.01), slightly moderate hypofractionated RT (20 × 2.35 Gy; β = 0.372, p = 0.0008), and aromatase inhibitor therapy (β = 0.258, p = 0.019) were independently associated with higher NT-proBNP at 24 months, whereas cardiac dose metrics were not. Seventeen patients developed CTRCD. NT-proBNP > 400 ng/L at 24 months was associated with CTRCD (OR = 6.5, 95% CI 1.24-33.85; p = 0.027).
CONCLUSION
NT-proBNP increased 2 years after breast RT and was associated with baseline level, cardiometabolic, RT fractionation, and endocrine factors. Elevated NT-proBNP could help to identify BC patients at higher risk of subclinical cardiac dysfunction, supporting longitudinal biomarker monitoring in cardio-oncology surveillance.
MeSH
Radiotherapy, Breast Neoplasms, Neoplasms, Biomarkers, Breast, Therapeutics