Early Cardiac Changes Due to Doxorubicin Based Chemotherapy and Radiotherapy in Early and Locally Advanced Carcinoma Breast Patients: An Observational Study

Vinin Nv Shyama

doi:10.4172/2155-9619.s7-004

Abstract

Objective: To evaluate prospectively the early cardiac changes from doxorubicin based chemotherapy and radiotherapy in breast cancer patients. Methods and Materials: 56 patients with early or locally advanced breast cancer were included in the study. ECG, ECHO and Equilibrium Radionuclide Ventriculography (ERV) was done at baseline, after chemotherapy, after radiotherapy and at 6 months of follow up. Results: In Group 1 patients who completed six cycles of chemotherapy before starting radiation, the mean LVEF decreased after chemotherapy and after RT(from 66.79 ± 3.73 to 63.45 ± 3.54 and 61.64 ± 4.26, p<0.05). In Group 2 patients who received six cycles of chemotherapy after completion of radiotherapy, mean LVEF decreased post RT and post chemotherapy (from 66.67 ± 4.33 to 66 ± 4.975 and 62.7 ± 2.92, p<0.05).In Group 3 patients also who received neoadjuvant chemotherapy, radiation and adjuvant chemotherapy there was a decline in mean LVEF.In Group 4 patients who received only adjuvant chemotherapy mean LVEF decreased after chemotherapy (from 67.25 ± 4.33 to 64.75 ± 2.062, p<0.05). LVEF was also measured by MUGA/ERV. In Group 1, mean LVEF decreased after chemotherapy and RT (from 58.14 ± 2.997 to 56.15 ± 3.144 and 56.21 ± 3.81, p<0.050. In Group 2 mean LVEF decreased after RT and chemotherapy (from 59.11 ± 1.41 to 58.67 ± 2.872 and 54.44 ± 1.81, p<0.05).In Group 3 patients, there was a decline in mean LVEF post neoadjuvant chemotherapy, after radiation and after adjuvant chemotherapy. In Group 4 mean LVEF decreased after chemotherapy (from 60 ± 1.63, to 58.75 ± 1.89, p<0.05). Conclusion: Our prospective study shows that a significant number of patients can develop a significant transient depression in ventricular function acutely after chemotherapy and radiotherapy as demonstrated by a decrease in LVEF by conventional ECHO and ERV scan.

Highlights

Anthracycline based chemotherapy and radiotherapy are an integral part in the primary treatment of breast cancer and majority of the women are offered either one or both the modalities as part of the treatment
In the current prospective study, we found immediately after chemotherapy a mild but significant impairment of the cardiac function in breast cancer patients treated with relatively low cumulative doses of Adriamycin
We found similar changes in FS and Mitral valve E point septal separation (MVEPSS) PEP/LVET indicating a depression in left ventricular function after chemotherapy and radiotherapy

Summary

Introduction

Anthracycline based chemotherapy and radiotherapy are an integral part in the primary treatment of breast cancer and majority of the women are offered either one or both the modalities as part of the treatment. The most serious side effect of anthracyclines is chronic cardiotoxicity, which can culminate in congestive .the first year after completion of chemotherapy in some cases it can present many years later [1,2,3]. Portions of heart are often unavoidably included during irradiation of breast and chest wall. Effects including pericarditis and reduced cardiac output have been seen at the completion of radiation therapy. ECG abnormalities and reduction in left ventricular ejection fraction were noticed after radiation treatment of breast cancer. J Nucl Med Radiat Ther S7: S7-004. doi:10.4172/2155-9619.1000S7-004

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Discussion

Conclusion