title: Acute cardiotoxicity with concurrent trastuzumab and radiotherapy including internal mammary chain nodes: a retrospective single-institution study.
abstract: OBJECTIVE
  To examine the acute cardiotoxicity of internal mammary chain (IMC) irradiation with concurrent trastuzumab.
  
  
  METHODS
  Clinical and cardiac function data were collected on 59 patients with early breast cancer who were treated with adjuvant trastuzumab and chemotherapy with or without radiotherapy (often including IMC) at BC Cancer Agency in 2005.
  
  
  RESULTS
  Forty-four of fifty-nine patients received adjuvant radiotherapy (RT). Thirteen had left-sided IMC RT. For left-sided RT, IMC inclusion increased the mean percentage dose to 5% of the heart, but the mean doses to 50% and 90% of the heart were similar. Median baseline left ventricular ejection fraction (LVEF) was 62% and similar in all groups. Median absolute decrease in LVEF after RT was 4%, which was not significantly different according to side or inclusion of IMCs. Trastuzumab was stopped in 11 of 59 patients (18.6%) due to decrease in LVEF. After median follow up of 15 months, three patients developed clinical congestive heart failure, none of whom received left-sided IMC RT.
  
  
  CONCLUSIONS
  There was no excess acute cardiotoxicity observed with the combination of left-sided IMC irradiation and concurrent trastuzumab.
authors.affiliation: British Columbia Cancer Agency, Vancouver, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Shaffer
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
authors.forename: Martin
authors.initials: M
authors.lastname: Rolles
authors.forename: Stephen
authors.initials: S
authors.lastname: Chia
authors.forename: Islam
authors.initials: I
authors.lastname: Mohamed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012189:Retrospective Studies; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab