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The effects of radiation therapy of early breast cancer on the cardiovascular system

  • Clinical Study
  • Published:
Hellenic Journal of Surgery

Abstract

Aim-Background

Improvements and developments in the treatment of early breast cancer include the use of breast-conserving therapy and radiotherapy in place of radical mastectomy, chemotherapy, monoclonal antibodies and hormone therapy. Radiation to the heart causes both acute and chronic symptoms of cardiac toxicity. Acute symptoms include acute pericarditis, pericardial effusion and arrhythmias. Among the long-term effects are constrictive pericarditis and increased atherosclerosis. The risk is greatest with left breast irradiation and radiation involving internal mammary lymph nodes. In this paper, we discuss the cardiovascular effects of radiation therapy treatment of early breast cancer.

Objectives-Methods

Twenty-eight patients with early breast cancer, aged between 30 and 50 years, undergoing breast conserving surgery, received irradiation from 2009-2010. All patients were irradiated with CT-guided simulation and 3D conformal treatment planning, which allows for better protection of normal tissue structures. They received 50Gy-60Gy with two tangential fields using a multileaf collimator-based linear accelerator, in 25 fractions of 2Gy /fraction five times per week. Nine of these patients received irradiation to the internal mammary lymph nodes which were included in the treatment field. The radiation oncologist and medical physicist took into account the dose-volume histogram (DVH) of the organs at risk: the heart, lung, and spinal cord. The maximum dose of radiation to the cardiovascular system was not considerable (V20<50, Dmax<60).

Results

All patients were followed up after radiotherapy at 3, 6, 12, 18, 24, 30 and 36 months. No acute and chronic symptoms of cardiac toxicity were noted. There was no evidence of side effects in the cardiovascular system, such as injuries to the endothelium of coronary vessels, ischaemic injury of the myocytes, or resultant fibrosis due to diastolic dysfunction.

Conclusions

Equipment for the treatment and planning of the field of radiotherapy through the use of conformal therapies, (3D, external beam radiotherapy) has significantly minimized the amount of radiation received by organs at risk, such as the heart. Further developments include the use of intensitymodulated radiotherapy (IMRT) and free breathing gating that serve to decrease the risk of cardiovascular complications, especially in young women with early breast cancer.

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Authors and Affiliations

  1. Radiation Oncology Department of General Hospital AHEPA, Aristotle University, Medical School, Thessaloniki, Greece

    S. Stylianidou

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  1. S. Stylianidou
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Stylianidou, S. The effects of radiation therapy of early breast cancer on the cardiovascular system. Hellenic J Surg 85, 160–164 (2013). https://doi.org/10.1007/s13126-013-0030-8

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  • DOI: https://doi.org/10.1007/s13126-013-0030-8

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