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Late Cardiac Effects of Adjuvant Radiotherapy and Chemotherapy in Early Breast Cancer

Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Potenza, Italy

To the Editor:

At our institution, we have discussed the Ganz et al¹ article, entitled "Late Cardiac Effects of Adjuvant Chemotherapy in Breast Cancers Survivors Treated on Southwest Oncology Group Protocol S8897." We would like to ask the authors some questions about the patients enrolled onto the study.

Was there any difference in cardiac events between patients who received thoracic radiation therapy (RT) and patients treated only with chemotherapy? For patients treated with RT, did you find more cardiac adverse events in patients treated with left thoracic radiotherapy?

Our preliminary experience of an observational study about cardiotoxicity in patients with early-stage left breast cancer in short-term follow-up showed stress-induced single photon emission computed tomography myocardial perfusion defects, mostly in the apical regions of the left ventricle, in patients without risk factors for coronary artery disease treated with anthracycline-containing chemotherapy and left thoracic RT.² We are now collecting more data on patients with early-stage left breast cancer in follow-up. For the patients with stress-induced myocardial perfusion defects multi slice computed tomographic coronary imaging did not detect any abnormalities of coronary epicardial vessels. The normality of multislice computed tomographic coronary angiograms seems to substantiate the hypothesis that short term myocardial perfusion defects are due mainly to microvascular damage.

The patients enrolled onto our study are observed very closely, to better define the clinical meaning of myocardial scintigraphic perfusion defects and to treat concomitant risk factors. One previous study concluded that cardiac symptoms occur more frequently in patients with single photon emission computed tomography myocardial perfusion defects³ and another study found a greater number of diagnosis of coronary artery disease and myocardial infarction in patients with left breast treated RT.⁴

Did you make any assessments on myocardial perfusion abnormalities among your patients? And if you did, were there any abnormalities? And for patients of which group of treatment? Did you find any difference between short-term follow-up and long-term follow-up cardiac events?

Some authors think that the mechanism of damage is microvascular or fibrotic after a short period from RT and macrovascular with damage to the epicardial coronary vessel after a longer period of follow-up.⁵

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Ganz PA, Hussey MA, Moinpour CM, et al: Late cardiac effects of adjuvant chemotherapy in breast cancer survivors treated on Southwest Oncology Protocol S8897. J Clin Oncol 26:1223-1230, 2008[Abstract/Free Full Text]

2. Gallucci G, Capobianco AM, Coccaro M, et al: Myocardial perfusion defects after radiation therapy and anthracycline chemotherapy for left breast cancer: A possible marker of microvascular damage: Three cases and review of the literature. Tumori 94:129-134, 2008[Medline]

3. Yu X, Prosnitz RR, Zhou S, et al: Symptomatic cardiac events following radiation therapy for left-sided breast cancer: Possible association with radiation therapy-induced changes in regional perfusion. J Clin Breast Cancer 4:193-197, 2003

4. Harris EE, Correa C, Hwang WT, et al: Late cardiac mortality and morbidity in early-stage breast cancer patients after breast-conservation treatment. J Clin Oncol 24:4100-4106, 2006[Abstract/Free Full Text]

5. Correa CR, Litt HI, Hwang WT, et al: Coronary artery findings after left-sided compared to right-sided radiation treatment for early stage breast cancer. J Clin Oncol 25:3031-3037, 2007[Abstract/Free Full Text]

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  Patricia A. Ganz, Carol M. Moinpour, and Joseph M. Unger
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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Google Scholar Articles by Coccaro, M. Articles by Gallucci, G. PubMed PubMed Citation Articles by Coccaro, M. Articles by Gallucci, G. Related Articles Related Reply Related Article