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Breast Cancer Research and Treatment

, Volume 174, Issue 1, pp 179–185 | Cite as

Evaluation of radiation-induced cardiac toxicity in breast cancer patients treated with Trastuzumab-based chemotherapy

  • Mohamed Abouegylah
  • Lior Z. Braunstein
  • Mohamed A. Alm El-Din
  • Andrzej Niemierko
  • Laura Salama
  • Mostafa Elebrashi
  • Samantha K. Edgington
  • Kyla Remillard
  • Brian Napolitano
  • George E. Naoum
  • Hoda E. Sayegh
  • Tessa Gillespie
  • Mohamed Farouk
  • Abdelsalam A. Ismail
  • Alphonse G. TaghianEmail author
Clinical trial
  • 166 Downloads

Abstract

Purpose

Patients with Her2-positive breast cancer treated with trastuzumab have higher rates of cardiotoxicity (CT). Left-breast radiation might increase the risk for CT from cardiac exposure to radiation. The goal of our study is to evaluate the contribution of radiotherapy (RT) in the development of CT in breast cancer patients receiving trastuzumab.

Methods

Two hundred and two patients were treated with RT and trastuzumab from 2000 to 2014. The RT plans for left-side disease were recalled from archives. The heart, each chamber, and left anterior descending artery (LAD) were independently contoured. New dose-volume histograms (DVH) were generated. Their serial left-ventricular ejection fractions (LVEF) were studied. CT for left and right side were compared using Fisher’s exact test. The DVH data were correlated with the predefined cardiac events using actuarial Cox regression analysis.

Results

Compared to the right sided, the left-side cases showed statistically significant development of arrhythmia (14.2%) versus (< 1%) (p < 0.001). Cardiac ischemia was found in 10 patients in left and one patient in right side (p = 0.011). The equivalent uniform dose (EUD) to the left ventricle (LV), right ventricle (RV), and LAD was significantly associated with decrease in LVEF by > 10% (p = 0.037, p = 0.023 and p = 0.049, respectively).

Conclusions

Among patients treated for left-sided lesions, there were no significant differences in EF decline. However, there was a higher rate of ischemia and arrhythmia compared to those with right-sided disease. The EUD index of LV, RV, and LAD could be considered as a parameter to describe the risk of radiation-induced CT.

Keywords

Radiotherapy Trastuzumab Cardiotoxicity Dose-volume histograms 

Notes

Compliance with ethical standards

Conflict of interest

All the authors declare that he/she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the IRB.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mohamed Abouegylah
    • 1
    • 2
  • Lior Z. Braunstein
    • 3
  • Mohamed A. Alm El-Din
    • 4
  • Andrzej Niemierko
    • 1
  • Laura Salama
    • 5
  • Mostafa Elebrashi
    • 6
  • Samantha K. Edgington
    • 1
  • Kyla Remillard
    • 1
  • Brian Napolitano
    • 1
  • George E. Naoum
    • 1
  • Hoda E. Sayegh
    • 1
  • Tessa Gillespie
    • 1
  • Mohamed Farouk
    • 2
  • Abdelsalam A. Ismail
    • 2
  • Alphonse G. Taghian
    • 1
    Email author
  1. 1.Department of Radiation Oncology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Clinical Oncology, Faculty of MedicineAlexandria UniversityAlexandriaEgypt
  3. 3.Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of Clinical Oncology, Faculty of MedicineTanta UniversityTantaEgypt
  5. 5.Charles E Schmidit COM, (FAU)Boca RatonUSA
  6. 6.Department of Clinical Oncology, Faculty of MedicineAin Shams UniversityCairoEgypt

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