The Effect of External Radiotherapy to the Left Ventricle Systolic Function in Locally Advanced Breast Cancer Patients

Background: Locoregional management in breast cancer patients includes surgery and radiation. Radiation increases the risk of the decreasing of cardiac ventricular performance and known as cardiotoxicity. This study aims to analyze the relationship between radiation exposure in locally advanced breast cancer patients with the left ventricular systolic function. Methods: The subjects in this study were patients with locally advanced breast cancer who underwent external radiation therapy after surgery procedure at Dr. Soetomo General Hospital in January 2021 – April 2021. Examination of left ventricular performance parameters was carried out using an invasive method, the transthoracic echocardiography. The performance parameters examined were left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Results: A total of 45 patients were recruited in this study. Twenty-two patients (22/45; 48.9%) underwent radiation therapy from the left side and 23 patients (23/45; 51.1%) from the right side. After external radiation, the number of patients with left ventricular dilatation were increased. On the left side, there were 6 patients (6/22; 27.6%) who experienced dilatation compared to before radiation (3 patients), while on the right side of the body there were 8 patients (8/22; 34.8%) who experienced dilatation compared to before radiation (6 patients). There was an increase in the number of patients who experienced a decrease in EFT and EFB after radiation, although the association was not significant. Almost all patients experienced a decrease in GLS values after radiation (44/45; 97.8%). Conclusion: There was an increase in the number of patients with left ventricular dilatation and decrease in EFT and EFB values after external radiation. Decreased GLS values were found in almost all patients who underwent external radiation in this study. Keywords: Radiation, locally advanced breast cancer, LVID, ejection fraction, GLS.

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Efficacy and safety of neoadjuvant chemotherapy of sequential doublets and dose dense plus trastuzumab in HER2-positive locally advanced breast cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.11089 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 11089-11089

Author(s):

E. Grande ◽

A. Sanchez-Muñoz ◽

A. García-Tapiador ◽

A. Ortega-Granados ◽

A. Jaén-Morago ◽

...

Keyword(s):

Breast Cancer ◽

Advanced Breast Cancer ◽

Cancer Patients ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Chemotherapeutic Agents ◽

Advanced Breast ◽

Breast Cancer Patients ◽

Her2 Positive ◽

Number Of Patients

11089 Background: Neoadjuvant therapy for breast cancer constitutes an excellent test to evaluate the sensitivity to chemotherapeutic agents and/or new biological agents against specific targets as trastuzumab and Her2. Furthermore, pathologic complete response (pCR) is a surrogate marker for disease-free and overall survival. Methods: The objective was to determine the efficacy in terms of pCR rates and the safety profile of the doublets plus trastuzumab schedule administered for the neoadjuvant setting of locally advanced breast cancer patients. A total of 20 patients with histologically confirmed locally invasive Her2-positive breast carcinoma were included. The median age was 43. Mean tumour size was 5.1 cm. Treatment consisted of a first sequence with epirubicin 90 mg/m2 and cyclophophamide 600 mg/m2 for 3 cycles, and a second sequence with paclitaxel 150 mg/m2 and gemcitabine 2500 mg/m2 for six cycles. All drugs were administered on day 1, every two weeks with prophylactic growth factor supports. Weekly trastuzumab was administered at a dose of 2mg/kg (4 mg/kg loading dose), concomitantly with paclitaxel and gemcitabine. Subsequently, patients underwent surgery and received radiotherapy and/or adjuvant hormonal therapy according to institutional practice Results: Objective clinical response was achieved in all patients. 10 (50%) pCR were obtained. With a median follow up of 18.2 months (3–38), 17 patients (85%) are alive without disease progression, and 3 (15%) showed recurrence and 1 of whom died. Treatment was well tolerated, 1 patient experienced 1 episode of grade 4 neutropenia and 2 patients had grade 3 neutropenia. 1 patient discontinued the treatment due to hypersensitivity reaction to paclitaxel. Asymptomatic decrease in cardiac ejection fraction with subsequent normalization was seen in 1 case. Conclusions: Despite of the small number of patients, results have shown a high pCR rate in this group of breast cancer patients with poor prognostic. The schedule seems to be feasible and tolerable and further studies with the doublet sequences plus trastuzumab are warranted on the neoadjuvant Her2 positive breast cancer patients No significant financial relationships to disclose.

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