Abstract
816 Background: The aim of the study was to evaluate late myocardial and pulmonary damage in breast cancer patients, after mastectomy and adjuvant sequential chemo-radiotherapy. Methods: Forty seven women with stage II and III breast cancer had mastectomy and sequential chemo-radiotherapy. In 40 patients (pts) chemotherapy with antracyclines and in 7- without antracyclines was administered. Radiotherapy included chest wall and regional lymph nodes, the specified dose was 45–50Gy /2 Gy. The high resolution computed tomography (HRCT) of the lungs, electrocardiography and echocardiography were performed after a mean time of 17 months, then, after a mean time of 33 months and finally, after a mean time of 65 months. Results: LUNGS-The first examination (after 17 monts) revealed no changes in 24 pts (51%). There were fibrotic changes in lung apex in 19 pts and 19 parietal fibrosis. In the second examination (after 33 months) a tendency to regression in parietal areas was observed (p=0.031). In third examination (after 65 months), the same percentage of pts −51% had no lung injury. The lung fibrosis was observed in 14 and parietal- in 13 pts.All these changes were discrete and asymptomatic and parietal fibrosis were invisible in chest X-ray. HEART- In first examination 7 of 47 pts had abnormal echocardiogram (ventricular dilatation, abnormal Left Ventricular Ejection Fraction). All of them received antracyclines. In 5 of them echocardiografic defect were asymptomatic and reversible at the time of second examination, in 2 -moderate toxicity was noted. The analysis of isodose distribution in all 7 cases excluded radiotherapy as a factor influencing toxicity. After 65 months, no new cardiac complications were observed and the improvement in echocardiography in 6 patients was observed (1 patient died because of disseminated disease). Conclusions: Modern postoperative radiotherapy caused no clinically significant lesions in lung and heart during 5 years of observation. Clinically important, reversible, myocardial changes, observed in 2 pts, seemed to be caused by antracyclines, but not by radiotherapy. No significant financial relationships to disclose.
Published Version
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