Anthracycline-based chemotherapy and 3DCRT resulted in no clinically abnormal CMR findings at 8.3 years, though higher LV mass correlated with ventricular mean dose, V10, and V25.
Observational (n=20)
Does cardiac magnetic resonance detect late cardiac injury in breast cancer survivors treated with anthracycline-based chemotherapy and 3DCRT regional nodal irradiation?
In breast cancer survivors treated with anthracyclines and 3DCRT with heart constraints, CMR at 8.3 years showed no overt clinical abnormalities, though subclinical correlations between radiation dose and LV mass were noted.
PURPOSE/OBJECTIVES: Node-positive breast cancer patients often receive chemotherapy and regional nodal irradiation. The cardiotoxic effects of these treatments, however, may offset some of the survival benefit. Cardiac magnetic resonance (CMR) is an emerging modality to assess cardiac injury. This is a pilot trial assessing cardiac damage using CMR in patients who received anthracycline-based chemotherapy and three-dimensional conformal radiotherapy (3DCRT) regional nodal irradiation using heart constraints. MATERIALS AND METHODS: Node-positive breast cancer patients (2000-2008) treated with anthracycline-based chemotherapy and 3DCRT regional nodal irradiation (including the internal mammary chain nodes) with heart ventricular constraints (V25 < 10%) were invited to participate. Cardiac tissues were contoured and analyzed separately for whole heart (pericardium) and for combined ventricles and left atrium (myocardium). CMR obtained ventricular function/dimensions, late gadolinium enhancement (LGE), global longitudinal strain (GLS), and extracellular volume fraction (ECV) as measures of cardiac injury and/or early fibrosis. CMR parameters were correlated with dose-volume constraints using Spearman correlations. RESULTS: Fifteen left-sided and five right-sided patients underwent CMR. Median diagnosis age was 50 (32-77). No patients had baseline cardiac disease before regional nodal irradiation. Median time after 3DCRT was 8.3 years (5.2-14.4). Median left-sided mean heart dose (MHD) was 4.8 Gy (1.1-11.2) and V25 was 5.7% (0-12%). Median left ventricular ejection fraction (LVEF) was 63%. No abnormal LGE was observed. No correlations were seen between whole heart doses and LVEF, LV mass, GLS, or LV dimensions. Increasing ECV did not correlate with increased heart or ventricular doses. However, correlations between higher LV mass and ventricular mean dose, V10, and V25 were seen. CONCLUSION: At a median follow-up of 8.3 years, this cohort of node-positive breast cancer patients who received anthracycline-based chemotherapy and regional nodal irradiation had no clinically abnormal CMR findings. However, correlations between ventricular mean dose, V10, and V25 and LV mass were seen. Larger corroborating studies that include advanced techniques for measuring regional heart mechanics are warranted.
Bergom et al. (Fri,) conducted a observational in Node-positive breast cancer (n=20). Anthracycline-based chemotherapy and 3DCRT was evaluated on Cardiac injury and/or early fibrosis measured by CMR parameters (LVEF, LGE, GLS, ECV) correlated with dose-volume constraints. Anthracycline-based chemotherapy and 3DCRT resulted in no clinically abnormal CMR findings at 8.3 years, though higher LV mass correlated with ventricular mean dose, V10, and V25.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: