Myocardial damage in breast cancer patients treated with adjuvant radiotherapy: a prospective study.

PURPOSE To look for early and late signs of cardiac side effects of postoperative radiotherapy in patients with left-sided breast cancer. METHODS AND MATERIALS Seventeen left-sided primary (Stage I-III) breast cancer patients considered eligible were recruited. Their computer tomography-based dose planning showed a part of the heart's left ventricle irradiated with at least 85-95% of the total dose. Twelve patients were examined both before treatment and an average of 13 months later, at a first follow-up. In partially mastectomized patients tangential opposed photon fields were used to the breast tissue, while in patients with modified radical mastectomy electrons were given to the thorax. Echocardiography and a bicycle ergometry stress test with myocardial perfusion scintigraphy were carried out before and after radiotherapy to assess if any myocardial damage could be detected. RESULTS Six of the 12 patients exhibited new fixed scintigraphic defects after radiotherapy indicating regional hypoperfusion. Four of them received treatment only to the breast after breast-conserving surgery. The localization of the defects corresponded well with the irradiated volume of the left ventricle. No deterioration in left ventricular systolic or diastolic function could be detected by echocardiography. CONCLUSIONS In this study half of the patients exhibited new scintigraphic defects that indicate radiation-induced myocardial damage, probably affecting the microcirculation. There were no changes on electrocardiography or any deterioration of the left ventricular function at this stage. Long-term follow-up is necessary to assess whether this finding is a prognostic sign for developing radiation-induced coronary artery disease.

[1]  G. Bonadonna,et al.  Handbook Of Medical Oncology , 1988 .

[2]  A. Recht,et al.  The 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy. , 1987, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  J. Bergman.  Cecil Textbook of Medicine. 19th edition , 1992, The Journal of the American Board of Family Medicine.

[4]  A. Luini,et al.  Local control and survival in early breast cancer: the Milan trial. , 1986, International journal of radiation oncology, biology, physics.

[5]  L. Kuller,et al.  Lipoprotein Lipids in Older People: Results From the Cardiovascular Health Study , 1992, Circulation.

[6]  K. Trott,et al.  Radiation induced heart disease in hypertensive rats. , 1988, International journal of radiation oncology, biology, physics.

[7]  B Fisher,et al.  Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. , 1985, The New England journal of medicine.

[8]  G. Ribeiro,et al.  Mortality patterns over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy. , 1989, Clinical radiology.

[9]  R. Niemtzow,et al.  Radiation Therapy and the Heart , 1986 .

[10]  W. C. Sheldon,et al.  Clinical and angiographic features of coronary artery disease after chest irradiation. , 1987, The American journal of cardiology.

[11]  G. Powis,et al.  The Toxicity of Anticancer Drugs , 1991 .

[12]  B Fisher,et al.  Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. , 1989, The New England journal of medicine.

[13]  E G DePuey,et al.  Optimal specificity of thallium-201 SPECT through recognition of imaging artifacts. , 1989, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[14]  A. Kapoor,et al.  Cancer and the Heart , 1986, Springer New York.

[15]  G. Stücklschweiger,et al.  [Evaluation of irradiation techniques in breast carcinoma using dose-volume histograms. Comparison of the heart and lung exposure]. , 1991, Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al].

[16]  Lee Goldman,et al.  Cecil Textbook of Medicine , 1985 .

[17]  G A Beller.  Myocardial perfusion imaging with thallium-201. , 1994, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[18]  M Baum,et al.  Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer. , 1988, Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer.

[19]  L. Rutqvist,et al.  Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish Cancer Registry. , 1990, British Journal of Cancer.

[20]  H. Høst,et al.  Postoperative radiotherapy in breast cancer--long-term results from the Oslo study. , 1986, International journal of radiation oncology, biology, physics.

[21]  M. J. Tamas,et al.  Normal SPECT thallium-201 bull's-eye display: gender differences. , 1988, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[22]  J. R. Stewart,et al.  Radiation injury to the heart. , 1995, International journal of radiation oncology, biology, physics.

[23]  I. Lax,et al.  Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. , 1992, International journal of radiation oncology, biology, physics.

[24]  L. F. Fajardo,et al.  Dose response in human and experimental radiation-induced heart disease. Application of the nominal standard dose (NSD) concept. , 1971, Radiology.

[25]  L. Hatle,et al.  The Natural History of Left Ventricular Filling Abnormalities: Assessment by Two‐Dimensional and Doppler Echocardiography , 1992 .

[26]  G. Amromin,et al.  THE SYNERGISM OF X-IRRADIATION AND CHOLESTEROL-FAT FEEDING ON THE DEVELOPMENT OF CORONARY ARTERY LESIONS. , 1964, Journal of atherosclerosis research.

[27]  L. Rutqvist,et al.  Morbidity of ischemic heart disease in early breast cancer 15-20 years after adjuvant radiotherapy. , 1994, International journal of radiation oncology, biology, physics.

[28]  L. F. Fajardo,et al.  Cancer and coronary artery disease. , 1978, International journal of radiation oncology, biology, physics.

[29]  L. F. Fajardo,et al.  Radiation-induced heart disease: an update. , 1984 .

[30]  L. Strender,et al.  Incidence of heart disease and functional significance of changes in the electrocardiogram 10 years after radiotherapy for breast cancer , 1986, Cancer.

[31]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[32]  E. W. Hancock,et al.  RADIATION-INDUCED HEART DISEASE. A STUDY OF TWENTY-FIVE PATIENTS. , 1967 .

[33]  J. Haybittle,et al.  Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer. , 1989, BMJ.

[34]  M Baum,et al.  Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. , 1994, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[35]  M. Gillin,et al.  Dose to the cardiac vascular and conduction systems in primary breast irradiation. , 1989, Medical dosimetry : official journal of the American Association of Medical Dosimetrists.

[36]  G. Gyenes,et al.  Pericardial irritation in breast cancer patients treated by curative postoperative radiotherapy--early results. , 1991, Strahlentherapie und Onkologie (Print).

[37]  C. Redmond,et al.  Eight-year Results of a Randomized Clinical Trial Comparing Total Mastectomy and Lumpectomy with or without Irradiation in the Treatment of Breast Cancer , 1989 .