Evaluation of cardiotoxicity five years after 2D planned, non-simulated, radiation therapy for left breast cancer

Kyriaki Pistevou-Gompaki¹, Apostolos Hatzitolios², Nikos Eleftheriadis², Evaggelos Boultoukas², George Ntaios², Ioannis Andronikidis², Ioannis Tzitzikas¹

¹Department of Radiation Oncology; ²First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University, Thessaloniki, Greece

Introduction: Radiation treatment has been associated with radiation induced cardiotoxicity, especially with older, long-outdated, techniques. Such complications include pericarditis, myocardial fibrosis, valvular injury, ischemic heart disease, and myocardial infarction.

Aim: To assess the effect of outdated breast radiation therapy (RT) – using a diagnostic CT scanner in the absence of a CT simulator – on cardiac function in women with stage II left breast cancer.

Patients and Methods: Sixty-two women under 65 with stage II left breast cancer who received post-operative RT using a diagnostic computed tomography scanner were studied between 1997 and 2001. Participants underwent a clinical interview, ECG, and echocardiography before and 6 months and 5 years after RT.

Results: There was no serious cardiotoxicity at 6 months and 5 years after radiotherapy. A 23% increase in hypertensive patients, and a slight decrease (2.3%) in ejection fraction was observed after 5 years, with 3 patients (5%) developing abnormalities. Two patients presented abnormal electrocardiographic findings within 6 months of RT.

Conclusion: Our study showed that RT for left breast cancer was not associated with significant alteration in heart morbidity or mortality within 5 years of treatment, despite the lack of a simulator.

Keywords: radiotherapy, breast cancer, cardiotoxicity, acute myocardial infraction, ischemic heart disease