Myocardial perfusion defects after radiation therapy and anthracycline chemotherapy for left breast cancer: a possible marker of microvascular damage. Three cases and review of the literature.

Radiation therapy to the thorax may induce early and late cardiac adverse effects if large parts of the heart have been included in the irradiation field and particularly if anthracycline-containing chemotherapy is concomitantly administered. We describe 3 cases of cardiotoxicity in patients with left breast cancer treated with anthracycline-containing chemotherapy and left thoracic radiotherapy. In 2 cases we observed asymptomatic electrocardiographic abnormalities of ventricular repolarization mimicking anterior myocardial ischemia and SPECT reversible myocardial perfusion defects. In 1 case we observed echocardiographic abnormalities of left ventricular wall motion and reversible myocardial perfusion abnormalities. We recommend close cardiac monitoring of patients treated with anthracycline chemotherapy and left thoracic radiotherapy to better understand the clinical impact of these abnormalities.

[1]  Wei-Ting Hwang,et al.  Late cardiac mortality and morbidity in early-stage breast cancer patients after breast-conservation treatment. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  Lawrence B Marks,et al.  The incidence and functional consequences of RT-associated cardiac perfusion defects. , 2005, International journal of radiation oncology, biology, physics.

[3]  D. Hollis,et al.  Persistence of radiation (RT)-induced cardiac perfusion defects 3-5 years post RT. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  Michael S Ewer,et al.  Cardiovascular complications of cancer therapy: diagnosis, pathogenesis, and management. , 2004, Circulation.

[5]  D. Hollis,et al.  Symptomatic cardiac events following radiation therapy for left-sided breast cancer: possible association with radiation therapy-induced changes in regional perfusion. , 2003, Clinical breast cancer.

[6]  L. Constine,et al.  Radiation-associated cardiovascular disease: manifestations and management. , 2003, Seminars in radiation oncology.

[7]  Lawrence B Marks,et al.  Myocardial perfusion changes in patients irradiated for left-sided breast cancer and correlation with coronary artery distribution. , 2001, International journal of radiation oncology, biology, physics.

[8]  J. De Sutter,et al.  The clinical value of nuclear medicine in the assessment of irradiation-induced and anthracycline-associated cardiac damage. , 2002, Annals of oncology : official journal of the European Society for Medical Oncology.

[9]  S. Underwood,et al.  Detection of defects in myocardial perfusion imaging in patients with early breast cancer treated with radiotherapy. , 2002, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[10]  L. Marks,et al.  Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: preliminary results. , 2001, International journal of radiation oncology, biology, physics.

[11]  C. Tondini,et al.  [Silent myocardial infarction in a patient treated with radiation therapy and polychemotherapy for Hodgkin's lymphoma]. , 1997, Cardiologia.

[12]  L. Rutqvist,et al.  Myocardial damage in breast cancer patients treated with adjuvant radiotherapy: a prospective study. , 1996, International journal of radiation oncology, biology, physics.

[13]  G. Bonadonna,et al.  Cardiac effects following adjuvant chemotherapy and breast irradiation in operable breast cancer. , 1994, Annals of oncology : official journal of the European Society for Medical Oncology.

[14]  L. Strender,et al.  Electrocardiographic changes after radiation therapy for carcinoma of the breast. Incidence and functional significance. , 1983, Acta radiologica. Oncology.

[15]  M. Etheridge,et al.  Electrocardiographic abnormalities following post-operative radiotherapy for carcinoma of the breast. , 1968, The British journal of radiology.

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