Open Access

Early cardiotoxicity after adjuvant concomitant treatment with radiotherapy and trastuzumab in patients with breast cancer

Tanja Marinko
Tanja Marinko
, 
Simona Borstnar
Simona Borstnar
, 
Rok Blagus
Rok Blagus
, 
Jure Dolenc
Jure Dolenc
 and 
Cvetka Bilban-Jakopin
Cvetka Bilban-Jakopin
   | Feb 25, 2018
Radiology and Oncology's Cover Image
About this article
Previous Article
Next Article
Cite
Article Category: Research Article
Published Online: Feb 25, 2018
Page range: 204 - 212
Received: Dec 04, 2017
Accepted: Dec 12, 2017
DOI: https://doi.org/10.2478/raon-2018-0011
© 2018 Tanja Marinko, Simona Borstnar, Rok Blagus, Jure Dolenc, Cvetka Bilban-Jakopin, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Patients and tumour characteristics, concomitant diseases

All N = 175 (100%) Left BC group N = 84 (48%) Right BC group N = 91 (52%) p value
Age in years (Median [Q1–Q3]) 58 (49–64) 59 (52–67) 55 (46–63) 0.0096
Menopause status Premenopause 90 (51.4%) 38 (45.2%) 52 (57.1%) 0.155
Pomenopause 85 (48.5%) 46 (54.8%) 39 (42.9%)
Histological type Ductal invasive 168 (96%) 81 (96.4%) 87 (95.6%) 1
Lobular invasive 4 (2.3%) 2 (2.4%) 2 (2.2%)
Other 3 (1.7%) 1 (1.2%) 2 (2.2%)
Histo-pathological grade G 1 2 (1.1%) 0 2 (2.2%) 0.337
G 2 48 (27.4%) 21 (25%) 27 (29.7%)
G 3 125 (71.5%) 63 (75%) 62 (68.1%)
Hormonal receptors ER positive 97 (55.4%) 53 (63%) 44 (48.3%) 0.851
PR positive 82 (46.8%) 43 (51.2%) 39 (42.8%)
ER in PR negative 73 (41.7%) 28 (33.3%) 45 (49.4%)
Concomitant disease Smoking 33 (19%) 13 (15%) 20 (22%) 0.365
Arterial hypertension 35 (20%) 21 (25%) 14 (15.4%) 0.161
Diabetes 3 (1.7%) 3 (3.4%) 0 0.108
Hyperlipidemia 30 (17.1%) 16 (19%) 14 (15.4%) 0,658
Known heart disease

All diseases had been already present at diagnosis of breast cancer. Group 1: mild aortic stenosis; Group 2: mitral valve prolapse; compensated hypertonic heart and symptomatic angina pectoris; undefined cardiomyopathy

 4 (2.3%) 1 (1.2%) 3 (3.3%) 0.621

Systemic treatment and surgical characteristics

All (N = 175) (%) Left BC Group (N = 84) (%) Right BC Group (N = 91) (%) P value
Anthracyclines
 Cumulative dose- mg/m2 BSA
 (Median [Q1–Q3]) 350 (292–499) 352 (295–497) 349 (290–499) 0.799
Taxanes
 Cumulative dose- mg/m2 BSA 297 297 298 0.783
 (Median [Q1–Q3]) (276–594) (281–422) (273–768)
Cyclophosphamide
 Cumulative dose- mg/m2 BSA 2316 2344 2268 0.482
 (Median [Q1–Q3]) (1758–2924) (1763–2992) (1758–2829)
CT Scheme
 AC/EC/FAC/FEC + taxanes 95 (54.3%) 40 (47.6%) 55 (60.4%) 0.235
 AC/EC/FAC/FEC without taxanes 69 (39.4%) 38 (45.3%) 31 (34.1%)
 Other 11 (6.3%) 6 (7.1%) 5 (5.5%)
Endocrine therapy
 Tamoxifen 39 (22.3%) 21 (25%) 18 (19.8%) 0.652
 Aromatase inhibitor 45 (25.7%) 26 (30.9%) 19 (20.8%)
 Other 10 (5.7%) 7 (8.3%) 3 (3.3%)
Trastuzumab
 Cumulative dose- mg/kg BSA 105 (97–114) 105 (97–116) 105 (97–112) 0.658
 (Median [Q1–Q3])
Type of surgery
 Mastectomy 91 (52%) 38 (45.2%) 53 (58.2%) 0.116
 Breast conserving surgery 84 (48%) 46 (54.8) 38 (41.8%)

Analysis of the difference in left ventricular ejection fractions (Δ LVEF)

All (N = 175) Left BC Group (N = 84) Right BC Group (N = 91) P value
LVEF0 (%) 65 (60–69) 65 (61–70) 63 (59.5–67) 0.0208
 (Median [Q1–Q3])
LVEF1 (%) 66 (62–70) 67 (64–70) 65 (60–70.5) 0.117
 (Median [Q1–Q3])
Analysis of Δ LVEF (n = 149) (n = 70) (n = 79) 0.562
 LVEF0 (%)-LVEF1(%) = Δ LVEF -2.22 (8.69) -1.78 (7.85) -2.60 (9.4) 95% CI: -2.004 – 3.648
 (Mean [SD])

Echocardiografic parameters (n = 175)

Left BC Group (n = 84) (median [Q1–Q3]) Right BC Group (n = 91) (median [Q1–Q3]) p value
LV EDD (cm) 4.6 (4.4–4.9) 4.6 (4.4–4.8) 0.913
95% CI (-0.10-0.10)
LV ESD (cm) 2.9 (2.6–3.1) 2.8 (2.5–3.2) 0.541
95% CI (-0.19–0.10)
LA tr (cm) 3.4 (3.2–3.8) 3.4 (3.2–3.7) 0.830
95% CI (-0.10–0.10)
LA long (cm) 4.4 (4.0–4.8) 4.5 (4.2–4.6) 0.979
95% CI (-0.10–0.10)
RA tr (cm) 3.2 (3.0–3.6) 3.4 (3.0–3.7) 0.298
95% CI (-0.20–0.00)
RA long (cm) 4.1 (3.8–4.4) 4.3 (3.9–4.4) 0.226
95% CI (-2.0–3.00)
LVEF (%) 68.5 (64–74.2) 68.0 (63.0–72.5) 0.758
95% CI (-2.0–3.00)
E/A 1.07 (0.80–1.23) 1.08 (0.87–1.32) 0.113
95% CI (-0.18–0.02)
E/Em 7.15 (6.27–9.26) 7.40 (6.18–8.68) 0.918
95% CI (-0.52–0.66)
s/d 1.368 (1.065–1.600) 1.149 (0.94–1.35) 0.002
95% CI ( 0.07–0.29)
TDI Sm (cm/s) 8.0 (7.0–9.1) 8.0 (7.0–9.1) 0.985
95% CI (-0.50–0.50)
TDI Em (cm/s) 10.0 (7.82–11.37) 10.0 (8.05–11.8) 0.547
95% CI (-0.10–0.50)

Radiotherapy treatment features

All (N = 175) (%) Left BC group (N = 84) (%) Right BC group (N = 91) (%) p value
RT field

parasternal lymph nodes were not included in the irradiated area
 Breast 70 (40%) 38 (45.3%) 32 (35.2%) 0.434
 Breast + scl 17 (9.7%) 9 (10.7%) 8 (8.8%)
 Thoracic wall 17 (9.7%) 8 (9.5%) 9 (9.9%)
 Thoracic wall + scl 71 (40.6%) 29 (34.5%) 42 (46.1%)
RT technique
 2D RT 139 (79.4%) 69 (82.1%) 70 (76.9%) 0.256
 3D CRT 25 (14.3%) 12 (14.3%) 13 (14.3%)
 Electrons +/- photons 11 (6.3%) 3 (3.6%) 8 (8.8%)
RT scheme
 25 × 2 Gy 14 (84.6%) 73 (86.9%) 75 (82.4%) 0.540
 17 or 18 × 2.5 Gy 27 (15.4%) 11 (13.1%) 16 (17.6%)

Pericardial effusion

ECHO All (N = 174) (%) Left BC Group (N = 83) (%) Right BC Group (N = 91) (%) p value
Pericard Normal 164 (94.3%) 74 (89%) 90 (99%) 0.007
Effusion 10 (5.7%) 9 (11%) 1 (1%)
eISSN:
1581-3207
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Radiology, Internal Medicine, Haematology, Oncology
Journal RSS Feed