Equilibrium radionuclide ventriculography in the assessment of cardiotoxicity of chemotherapy and chemoradiotherapy in patients with breast cancer

Abstract

BACKGROUND: Multidrug chemotherapy increases the efficacyof the treatment, but at the same time rises its cardiotoxicity. Themajority of cardiac complications are caused by anthracyclines.Radiation therapy may intensify cardiotoxicity. The aim of thisstudy was to determine early changes of cardiac function usingradionuclide ventriculography in patients with breast cancer andto compare the toxicity of AC and AT chemotherapy programs.

MATERIAL AND METHODS: The study included 71 patientswith breast cancer between the ages of 38 and 71 years. Allpatients after surgery were qualified for chemotherapy, and for37 (52%) of them subsequent irradiation treatment was planned.Patients received chemotherapy according to the scheme: AC— 47 patients (66%) and AT — 24 patients (34%). Patients wereirradiated using a photon beam (4 to 6 MeV) and an electronbeam (6–15 MeV). In all patients, before and six months afterthe treatment, radionuclide ventriculography was performed.RESULTS: In all 71 patients a reductions in left ventricularejection fraction (EF) and in peak filling rate (PFR) as well asan increase in the end-systolic and end-diastolic volumes (ESvol,EDvol) were observed. AC chemotherapy, where cumulativeanthracycline dose was higher, significantly decreased leftventricular ejection fraction and PFR and increased ESvol. AfterAT chemotherapy the EF reduction proved to be smaller. Radiotherapydid not significantly lower the value of EF as comparedto the group of patients who underwent chemotherapy.

CONCLUSIONS: Radionuclide ventriculography is a usefulmethod of evaluating the cardiotoxicity of the treatment. Earlyindicators of myocardial damage are EF, PFR, ESvol and EDvol.AC chemotherapy, where the average cumulative dose of anthracyclineswas higher, caused more cardiotoxic effects thanAT chemotherapy.Applying additional radiotherapy did not significantly increasethe cardiotoxicity of the treatment.