[Risk of cardiotoxicity of combination treatment radiotherapy and chemotherapy of locally advanced breast carcinoma stage III].
BACKGROUND
Locally advanced breast carcinoma represents a disease, where the combination of treatment--chemotherapy with antracycline and radiotherapy--is generally accepted as standard therapy. This management can be limited by cardiotoxicity. Cardiotoxicity is a rare complication of breast cancer treatment and the incidence and severity of cardiotoxicity are dependent on cumulative dose of antracyline, the type and combination of drugs used, the presence of coexsistin diseases (cardiac diseases, diabetes mellitus), risk faktors and use, the way of radiotherapy and combination therapy in the treatment of locally advanced breast carcinoma.


METHODS
64 patients (average age 57) with locally advanced breast carcinoma stage III were treated chemotherapy FAC. The chemotherapy consisted of doxorubicin 50 mg/m2, i.v. infusion day 1, cyclophosphamid 500 mg/m2, day 1 a 5-flourouracil 500 mg/m2 - day 1 and day 8. Every 21 days, sequential surgery of breast carcinoma, adjuvant chemotherapy FAC and irradiation. Patients had 6 cycles of chemoterapy. Cumulative doxorubicine dose was 300-350 mg/m2, radiotherapy was undertaken in all cases. It was administered after chemotherapy and was planned according to the well-established technigue. It included the chest wall and regional lymph nodes after mastectomy and breast with scar and regional lymph nodes after parcial mastectomy. The condition of the heart was studied using echocardiography which were performed before start of chemotherapy FAC and during of chemotherapy after 1 year of beginning of combination treatment chemotherapy FAC and radiotherapy after 2, 3, 4, 5 and more years.


RESULTS
Occurrence of cardiotoxicity during 6 cycles of (neoadjuvant and adjutant) chemotherapy FAC was monitored by LVEF. Cardiotoxicity was find out at 9 patients from 64 patients of the group (14%)-toxicity grade (G) 1 and G2. After combination treatment neoadjuvant and adjuvant chemotherapy FAC and radiotherapy was found out at 9 patients from 63 patients of the group (14.3%)-cardiotoxity G1. Cardiotoxicity after combination of chemotherapy FAC and radiotherapy after 2 years was found out at 6 patients (9.7%) G1 and cardiotoxicity after combined treatment of chemotherapy FAC and radiotherapy was found out after 3, 4, 5, and more years--at 3 patients (5.9%)--cardiotoxicity G1. Incidence of clinical cardiac failure was 4.7%--1 patient died of cardiac failure and 2 patients died of heart attack.


CONCLUSIONS
The incidence of the risk of cardiotoxicity is rare event but the risk of damage to the cardiovascular system following radiotherapy and antracyclines exists, although cardiotoxic effects of both these drugs groups have been well known. The cardiotoxicity apperas in the process of the chemotherapy with doxorubicine, in combination of the chemotherapy with doxorubicine and radiotherapy, but also in longer time intervals from the beginning of the treatment (2, 3, 4, 5 and more years).
Bustová
I
I
Onkologické Oddēlení, Nemocnice Ceské Budējovice A.S.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006321:Heart / Q000187:drug effects* / Q000528:radiation effects*; D006801:Humans; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage
D018943:Anthracyclines; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil