Pathophysiologic Impact of Doxorubicin and Radiation Therapy on the Heart of Patients Treated for Breast Cancer
Abstract
Purpose: To determine the incidence and dose dependence of regional cardiac perfusion abnormalities in patients with left-sided breast cancer treated with radiation therapy (RT) with and without doxombicin (Dox). Methods: Thirty-three patients with left-sided breast cancer underwent cardiac perfusion imaging using single photon emission computed tomography (SPECT) pre-chemothempy, pre-RT, and 6 months post-RT. SPECT perfusion images were registered onto 3- dimensional (3D) RT dose distributions. The volume of heart in the RT field was quantified and the regional RT dose was calculated. A decrease in regional cardiac perfusion was assessed subjectively by visual inspection and objectively using image fusion software. Results: Overall there was a 55% incidence in new visibly detectable perfusion defects at 6 months post-RT. In patients receiving chemotherapy (CTx) this incidence was 71% versus 38% in patients having RT only. A dose-dependent perfusion defect is seen at 6 months with no defect appreciated at 0-10 Gy, whereas there was a 20% decrease in regional cardiac perfusion identified between 41- 50 Gy. One of thirty-three patients had a decrease in left ventricle ejection fraction of greater than 10% at 6 months, and 2/33 patients developed transient pericarditis. No events of myocardial infarction (MI) or congestive heart failure (CHF) have occurred. Conclusions: RT causes cardiac perfusion defects 6 months post-RT in most patients. Dox-based CTx may increase the frequency of this effect. Long-term follow-up is needed to assess whether these perfusion changes are transient or permanent and to determine if these findings are associated with changes in overall cardiac function and clinical outcome.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 01, 2000
- Accession Number
- ADB259684
Entities
People
- Patricia Hardenbergh
Organizations
- Duke University Hospital