Author/Editor		Marinko, Tanja; Borštnar, Simona; Blagus, Rok; Dolenc, Jure; Bilban-Jakopin, Cvetka
Title		Early cardiotoxicity after adjuvant concomitant treatment with radiotherapy and trastuzumab in patients with breast cancer
Type		članek
Vol. and No.		, št. 2
Publication year		2018
Volume		str. str. 204-212
ISSN		1318-2099 - Radiology and oncology
Language		eng
Abstract		The purpose of the study was to find out whether there is a difference in the early parameters of cardiotoxicity (left ventricular ejection fraction [LVEF] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) between the two groups of patients: the patients treated for left breast cancer (left breast cancer group) and those treated for the right breast cancer (right breast cancer group), after the treatment had been completed. Patients and methods. The study included 175 consecutive patients with human epidermal growth factor receptor- 2 (HER2) positive early breast cancer, treated concurrently with trastuzumab and radiotherapy (RT), between June 2005 and December 2010. Echocardiography with LVEF was performed before adjuvant RT (LVEF0) and in all patients after the concurrent treatment had been completed (LVEF1) as well as we carried out the NT-proBNP measurements. The difference (%) between LVEF0 and LVEF1 was analysed (% LVEF = LVEF0 - LVEF1) and compared between the two groups. Results. There were 84 patients in the left and 91 in the right breast cancer group. Median observation time was 57 (37%71) months. Mean % LVEF (%) was -1.786% in the left and -2.607% in the right breast cancer group (p = 0.562, CI: -2.004 to 3.648). Median NT-proBNP were 111.0 ng/l in the left and 90.0 ng/l in the right breast cancer group (p = 0.545). Echocardiography showed that the patients in the left breast cancer group did not have significantly worse systolic and diastolic left ventricular function in comparison with the patients in the right breast cancer group, but, they had higher incidence of pericardial effusion (9 [11%] vs. 1 [1%]) (p = 0.007). Conclusions. We did not find any significant differences in the early parameters of cardiotoxicity (LVEF, NT-proBNP) between the two groups we observed. Those patients who were irradiated on the left breast/chest wall had higher incidence of pericardial effusion.Z raziskavo smo želeli preveriti ali je med bolnicami, ki so ob zdravljenju s trastuzumabom pooperativno obsevale levo (skupina 1) oziroma desno (skupina 2) dojko/prsno steno, po zaključenem zdravljenju pomembna razlika v zgodnjih kazalcih kardiotoksičnosti. To smo merili z iztisnim deležem levega prekata (LVEF) in N-končnim pro-B natriuretičnim peptidom [NT-proBNP]). Bolniki in metode. V raziskavo smo vključili 175 zaporednih bolnic s pozitivnim HER2 rakom dojke, ki so v okviru dopolnilnega zdravljenja med junijem 2005 in decembrom 2010 prejemale trastuzumab ter smo jim sočasno pooperativno obsevali dojko/prsno steno. Vsem bolnicam smo ob začetku dopolnilnega zdravljenja naredili izhodiščno preiskavo srca, bodisi ehokardiografijo ali radioizotopno ventrikulografijo (LVEF0) ter naredili kontrolne meritve po zaključenem zdravljenju (LVEF1), hkrati pa smo jim določili vrednosti NT-proBNP. Analizirali smo razliko med LVEF0 in LVEF1 (% LVEF = LVEF0 -LVEF1) ter ju primerjali med skupinama. Rezultati. V skupini 1 je sodelovalo 84, v skupini 2 pa 91 bolnic. Mediani čas sledenja bolnic je bil 57 (37%71) mesecev. V skupini 1 je bila srednja vrednost % LVEF (%) -1,786 %, v skupini 2 pa -2,607 % (p = 0,562; interval zaupanja [CI]: od -2,004 do 3,648). Srednja vrednost NT-proBNP je bila 111,0 ng/l v skupini 1 in 90,0 ng/l v skupini 2 (p = 0,545). Primerjava ehokardiografskih kazalcev je pokazala, da bolnice iz skupine 1 niso imele pomembno slabše sistolične in diastolične funkcije levega prekata kot bolnice iz skupine 2, imele pa so pomembno več perikardnih izlivov (9 [11 %]) kot bolnice v skupini 2 (1 [1 %]) (p = 0,007). Zaključki. Med opazovanima skupinama nismo našli značilnih razlik v zgodnjih kazalcih kardiotoksičnosti (LVEF, NTproBNP). Bolnice, pri katerih smo obsevali levo dojko/prsno steno, so imele značilno več perikardnih izlivov.
Keywords		radioterapija dopolnilna radioterapija kardiotoksičnost rak dojke radiotherapy adjuvant radiotherapy cardiotoxicity breast cancer