Prospective assessment of radiotherapy-associated cardiac toxicity in breast cancer patients

Analysis of data 3 to 6 years after treatment

Robert G. Prosnitz, Jessica L. Hubbs, Elizabeth S. Evans, Sumin Zhou, Xiaoli Yu, Michael A. Blazing, Donna R. Hollis, Andrea Tisch, Terence Z. Wong, Salvador Borges-Neto, Patricia H. Hardenbergh, Lawrence B. Marks

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

BACKGROUND. Radiation therapy (RT) to the left breast/chest wall has been linked with cardiac dysfunction. Previously, the authors identified cardiac perfusion defects in approximately 50% to 60% of patients 0.5 to 2 years post-RT. In the current study, they assessed the persistence of these defects 3 to 6 years post-RT. METHODS. From 1998 to 2006, 160 patients with left-sided breast cancer were enrolled onto an Institutional Review Board-approved, prospective study. All patients received tangential photons to the left breast/chest wall. Patients had pre-RT and serial post-RT single-photon emission computed tomography (SPECT) scans to assess changes in regional cardiac perfusion, wall motion, and ejection fraction (EF). Forty-four patients had SPECT scans 3 to 6 years post-RT and were evaluable for the current analysis. RESULTS. The overall incidence of perfusion defects at 3 years, 4 years, 5 years, and 6 years was 52% (11 of 21 patients), 71% (17 of 24 patients), 67% (12 of 18 patients), and 57% (4 of 7 patients), respectively. The rate of abnormal SPECT scans 3 to 6 years post-RT in patients who had scans at 0.5 to 2 years that were either all abnormal, intermittently abnormal, or all normal was 80%, 67%, and 63%, respectively. The incidence of wall motion abnormalities in patients with or without perfusion defects 3 to 6 years post-RT was low and did not differ statisti-cally (17% vs 7.1%, respectively; P =.65), as was the incidence of reductions in EF of ≥5% (27% vs 36%o, respectively; P = .72). CONCLUSIONS. The results from this study indicated that RT-induced perfusion defects may persist or initially may appear 3 to 6 years post-RT in a high percentage of patients. However, these defects were not associated with changes in regional wall motion or EF. Additional study will be needed to determine the clinical relevance of these defects. In the meantime, the authors believe that every effort should be made to minimize incidental irradiation of the heart while maintaining adequate coverage of target volumes.

Original languageEnglish (US)
Pages (from-to)1840-1850
Number of pages11
JournalCancer
Volume110
Issue number8
DOIs
StatePublished - Oct 15 2007

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Radiotherapy
Breast Neoplasms
Perfusion
Therapeutics
Single-Photon Emission-Computed Tomography
Thoracic Wall
Cardiotoxicity
Incidence
Breast
Research Ethics Committees
Photons
Prospective Studies

Keywords

  • Breast cancer
  • Cardiotoxicity
  • Prospective trial
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Prospective assessment of radiotherapy-associated cardiac toxicity in breast cancer patients : Analysis of data 3 to 6 years after treatment. / Prosnitz, Robert G.; Hubbs, Jessica L.; Evans, Elizabeth S.; Zhou, Sumin; Yu, Xiaoli; Blazing, Michael A.; Hollis, Donna R.; Tisch, Andrea; Wong, Terence Z.; Borges-Neto, Salvador; Hardenbergh, Patricia H.; Marks, Lawrence B.

In: Cancer, Vol. 110, No. 8, 15.10.2007, p. 1840-1850.

Research output: Contribution to journalArticle

Prosnitz, RG, Hubbs, JL, Evans, ES, Zhou, S, Yu, X, Blazing, MA, Hollis, DR, Tisch, A, Wong, TZ, Borges-Neto, S, Hardenbergh, PH & Marks, LB 2007, 'Prospective assessment of radiotherapy-associated cardiac toxicity in breast cancer patients: Analysis of data 3 to 6 years after treatment', Cancer, vol. 110, no. 8, pp. 1840-1850. https://doi.org/10.1002/cncr.22965
Prosnitz, Robert G. ; Hubbs, Jessica L. ; Evans, Elizabeth S. ; Zhou, Sumin ; Yu, Xiaoli ; Blazing, Michael A. ; Hollis, Donna R. ; Tisch, Andrea ; Wong, Terence Z. ; Borges-Neto, Salvador ; Hardenbergh, Patricia H. ; Marks, Lawrence B. / Prospective assessment of radiotherapy-associated cardiac toxicity in breast cancer patients : Analysis of data 3 to 6 years after treatment. In: Cancer. 2007 ; Vol. 110, No. 8. pp. 1840-1850.
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abstract = "BACKGROUND. Radiation therapy (RT) to the left breast/chest wall has been linked with cardiac dysfunction. Previously, the authors identified cardiac perfusion defects in approximately 50{\%} to 60{\%} of patients 0.5 to 2 years post-RT. In the current study, they assessed the persistence of these defects 3 to 6 years post-RT. METHODS. From 1998 to 2006, 160 patients with left-sided breast cancer were enrolled onto an Institutional Review Board-approved, prospective study. All patients received tangential photons to the left breast/chest wall. Patients had pre-RT and serial post-RT single-photon emission computed tomography (SPECT) scans to assess changes in regional cardiac perfusion, wall motion, and ejection fraction (EF). Forty-four patients had SPECT scans 3 to 6 years post-RT and were evaluable for the current analysis. RESULTS. The overall incidence of perfusion defects at 3 years, 4 years, 5 years, and 6 years was 52{\%} (11 of 21 patients), 71{\%} (17 of 24 patients), 67{\%} (12 of 18 patients), and 57{\%} (4 of 7 patients), respectively. The rate of abnormal SPECT scans 3 to 6 years post-RT in patients who had scans at 0.5 to 2 years that were either all abnormal, intermittently abnormal, or all normal was 80{\%}, 67{\%}, and 63{\%}, respectively. The incidence of wall motion abnormalities in patients with or without perfusion defects 3 to 6 years post-RT was low and did not differ statisti-cally (17{\%} vs 7.1{\%}, respectively; P =.65), as was the incidence of reductions in EF of ≥5{\%} (27{\%} vs 36{\%}o, respectively; P = .72). CONCLUSIONS. The results from this study indicated that RT-induced perfusion defects may persist or initially may appear 3 to 6 years post-RT in a high percentage of patients. However, these defects were not associated with changes in regional wall motion or EF. Additional study will be needed to determine the clinical relevance of these defects. In the meantime, the authors believe that every effort should be made to minimize incidental irradiation of the heart while maintaining adequate coverage of target volumes.",
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AU - Prosnitz, Robert G.

AU - Hubbs, Jessica L.

AU - Evans, Elizabeth S.

AU - Zhou, Sumin

AU - Yu, Xiaoli

AU - Blazing, Michael A.

AU - Hollis, Donna R.

AU - Tisch, Andrea

AU - Wong, Terence Z.

AU - Borges-Neto, Salvador

AU - Hardenbergh, Patricia H.

AU - Marks, Lawrence B.

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N2 - BACKGROUND. Radiation therapy (RT) to the left breast/chest wall has been linked with cardiac dysfunction. Previously, the authors identified cardiac perfusion defects in approximately 50% to 60% of patients 0.5 to 2 years post-RT. In the current study, they assessed the persistence of these defects 3 to 6 years post-RT. METHODS. From 1998 to 2006, 160 patients with left-sided breast cancer were enrolled onto an Institutional Review Board-approved, prospective study. All patients received tangential photons to the left breast/chest wall. Patients had pre-RT and serial post-RT single-photon emission computed tomography (SPECT) scans to assess changes in regional cardiac perfusion, wall motion, and ejection fraction (EF). Forty-four patients had SPECT scans 3 to 6 years post-RT and were evaluable for the current analysis. RESULTS. The overall incidence of perfusion defects at 3 years, 4 years, 5 years, and 6 years was 52% (11 of 21 patients), 71% (17 of 24 patients), 67% (12 of 18 patients), and 57% (4 of 7 patients), respectively. The rate of abnormal SPECT scans 3 to 6 years post-RT in patients who had scans at 0.5 to 2 years that were either all abnormal, intermittently abnormal, or all normal was 80%, 67%, and 63%, respectively. The incidence of wall motion abnormalities in patients with or without perfusion defects 3 to 6 years post-RT was low and did not differ statisti-cally (17% vs 7.1%, respectively; P =.65), as was the incidence of reductions in EF of ≥5% (27% vs 36%o, respectively; P = .72). CONCLUSIONS. The results from this study indicated that RT-induced perfusion defects may persist or initially may appear 3 to 6 years post-RT in a high percentage of patients. However, these defects were not associated with changes in regional wall motion or EF. Additional study will be needed to determine the clinical relevance of these defects. In the meantime, the authors believe that every effort should be made to minimize incidental irradiation of the heart while maintaining adequate coverage of target volumes.

AB - BACKGROUND. Radiation therapy (RT) to the left breast/chest wall has been linked with cardiac dysfunction. Previously, the authors identified cardiac perfusion defects in approximately 50% to 60% of patients 0.5 to 2 years post-RT. In the current study, they assessed the persistence of these defects 3 to 6 years post-RT. METHODS. From 1998 to 2006, 160 patients with left-sided breast cancer were enrolled onto an Institutional Review Board-approved, prospective study. All patients received tangential photons to the left breast/chest wall. Patients had pre-RT and serial post-RT single-photon emission computed tomography (SPECT) scans to assess changes in regional cardiac perfusion, wall motion, and ejection fraction (EF). Forty-four patients had SPECT scans 3 to 6 years post-RT and were evaluable for the current analysis. RESULTS. The overall incidence of perfusion defects at 3 years, 4 years, 5 years, and 6 years was 52% (11 of 21 patients), 71% (17 of 24 patients), 67% (12 of 18 patients), and 57% (4 of 7 patients), respectively. The rate of abnormal SPECT scans 3 to 6 years post-RT in patients who had scans at 0.5 to 2 years that were either all abnormal, intermittently abnormal, or all normal was 80%, 67%, and 63%, respectively. The incidence of wall motion abnormalities in patients with or without perfusion defects 3 to 6 years post-RT was low and did not differ statisti-cally (17% vs 7.1%, respectively; P =.65), as was the incidence of reductions in EF of ≥5% (27% vs 36%o, respectively; P = .72). CONCLUSIONS. The results from this study indicated that RT-induced perfusion defects may persist or initially may appear 3 to 6 years post-RT in a high percentage of patients. However, these defects were not associated with changes in regional wall motion or EF. Additional study will be needed to determine the clinical relevance of these defects. In the meantime, the authors believe that every effort should be made to minimize incidental irradiation of the heart while maintaining adequate coverage of target volumes.

KW - Breast cancer

KW - Cardiotoxicity

KW - Prospective trial

KW - Radiation therapy

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