Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: preliminary results.
OBJECTIVE
To determine the incidence and dose dependence of regional cardiac perfusion abnormalities in patients with left-sided breast cancer treated with radiation therapy (RT) with and without doxorubicin (Dox).


METHODS
Twenty patients with left-sided breast cancer underwent cardiac perfusion imaging using single photon emission computed tomography (SPECT) prechemotherapy, pre-RT, and 6 months post-RT. SPECT perfusion images were registered onto 3-dimensional (3D) RT dose distributions. The volume of heart in the RT field was quantified, and the regional RT dose was calculated. A decrease in regional cardiac perfusion was assessed subjectively by visual inspection and objectively using image fusion software. Ten patients received Dox-based chemotherapy (total dose 120-300 mg/m(2)), and 10 patients had no chemotherapy. RT was delivered by tangent beams in all patients to a total dose of 46-50 Gy.


RESULTS
Overall, 60% of the patients had new visible perfusion defects 6 months post-RT. A dose-dependent perfusion defect was seen at 6 months with minimal defect appreciated at 0-10 Gy, and a 20% decrease in regional perfusion at 41-50 Gy. One of 20 patients had a decrease in left ventricle ejection fraction (LVEF) of greater than 10% at 6 months; 2/20 patients had developed transient pericarditis. No instances of myocardial infarction or congestive heart failure (CHF) have occurred.


CONCLUSIONS
RT causes cardiac perfusion defects 6 months post-RT in most patients. Long-term follow-up is needed to assess whether these perfusion changes are transient or permanent and to determine if these findings are associated with changes in overall cardiac function and clinical outcome.
Hardenbergh
P H
PH
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
Munley
M T
MT
Bentel
G C
GC
Kedem
R
R
Borges-Neto
S
S
Hollis
D
D
Prosnitz
L R
LR
Marks
L B
LB
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D003326:Coronary Circulation / Q000187:drug effects* / Q000528:radiation effects*; D004307:Dose-Response Relationship, Radiation; D004317:Doxorubicin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000528:radiation effects*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016277:Ventricular Function, Left / Q000187:drug effects / Q000528:radiation effects
D000970:Antineoplastic Agents; D004317:Doxorubicin