Nuclear Medicine & Radiation Therapy

Early Cardiac Changes Due to Doxorubicin Based Chemotherapy and Radiotherapy in Early and Locally Advanced Carcinoma Breast Patients: An Observational Study

Abstract

Vinin NV, Shyama Prem S, Ajithananathakrishna Pillai, Reddy KS, Dhanapathi Halanaik and Sudhakar Kotlapati

Objective: To evaluate prospectively the early cardiac changes from doxorubicin based chemotherapy and radiotherapy in breast cancer patients.
Methods and Materials: 56 patients with early or locally advanced breast cancer were included in the study. ECG, ECHO and Equilibrium Radionuclide Ventriculography (ERV) was done at baseline, after chemotherapy, after radiotherapy and at 6 months of follow up.
Results: In Group 1 patients who completed six cycles of chemotherapy before starting radiation, the mean LVEF decreased after chemotherapy and after RT(from 66.79 ± 3.73 to 63.45 ± 3.54 and 61.64 ± 4.26, p<0.05). In Group 2 patients who received six cycles of chemotherapy after completion of radiotherapy, mean LVEF decreased post RT and post chemotherapy (from 66.67 ± 4.33 to 66 ± 4.975 and 62.7 ± 2.92, p<0.05).In Group 3 patients also who received neoadjuvant chemotherapy, radiation and adjuvant chemotherapy there was a decline in mean LVEF.In Group 4 patients who received only adjuvant chemotherapy mean LVEF decreased after chemotherapy (from 67.25 ± 4.33 to 64.75 ± 2.062, p<0.05).
LVEF was also measured by MUGA/ERV. In Group 1, mean LVEF decreased after chemotherapy and RT (from 58.14 ± 2.997 to 56.15 ± 3.144 and 56.21 ± 3.81, p<0.050. In Group 2 mean LVEF decreased after RT and chemotherapy (from 59.11 ± 1.41 to 58.67 ± 2.872 and 54.44 ± 1.81, p<0.05).In Group 3 patients, there was a decline in mean LVEF post neoadjuvant chemotherapy, after radiation and after adjuvant chemotherapy. In Group 4 mean LVEF decreased after chemotherapy (from 60 ± 1.63, to 58.75 ± 1.89, p<0.05).
Conclusion: Our prospective study shows that a significant number of patients can develop a significant transient depression in ventricular function acutely after chemotherapy and radiotherapy as demonstrated by a decrease in LVEF by conventional ECHO and ERV scan.