title: The acute skin and heart toxicity of a concurrent association of trastuzumab and locoregional breast radiotherapy including internal mammary chain: a single-institution study.
abstract: BACKGROUND
  To evaluate the skin and heart toxicity of a concurrent adjuvant trastuzumab-radiotherapy for breast cancer (BC), especially in the case of internal mammary chain (IMC) irradiation.
  
  
  METHODS
  Prospective study of 106 patients treated between 06/2003 and 03/2007 by concurrent trastuzumab-radiotherapy for non-metastatic BC. Left ventricular ejection fractions (LVEF) was assessed at baseline, before and after radiotherapy and then every 4-6 months. All toxicities were evaluated using CTCAEV3.
  
  
  RESULTS
  Median age was 52 years (25-76). Chemotherapy with anthracycline was administered in 92% of patients. All patients received trastuzumab every three weeks (8 mg/kg followed by 6 mg/kg) for a median duration of 12 months (3-40). The IMC was irradiated in 83% of patients. There were: 87 grade 1, 14 grade 2 and 2 grade 3 skin reactions. There were 13 oesophagitis: 9 grade 1; 3 grade 2, and 1 grade 3. Out of 101 patients with assessments after 6 months, late telangiectasia grade 1 occurred in 5 patients, local pain grade 1 in 19 patients and grade 2 in 3 patients, fibrosis grade 1 in 16 patients. A reversible grade ≥2 left ventricular systolic dysfunction occurred in 6 patients.
  
  
  CONCLUSIONS
  In this prospective study of breast cancer patients treated with trastuzumab-radiotherapy with, in most cases, anthracycline-based chemotherapy and IMC irradiation, both the rate of abnormal LVEF after concurrent trastuzumab-radiotherapy and the skin toxicity were deemed acceptable. Further follow-up is needed.
authors.affiliation: Department of Radiation Oncology, Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France.
authors.forename: Lucas
authors.initials: L
authors.lastname: Caussa
authors.forename: Youlia M
authors.initials: YM
authors.lastname: Kirova
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gault
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pierga
authors.forename: Alexia
authors.initials: A
authors.lastname: Savignoni
authors.forename: François
authors.initials: F
authors.lastname: Campana
authors.forename: Rémi
authors.initials: R
authors.lastname: Dendale
authors.forename: Alain
authors.initials: A
authors.lastname: Fourquet
authors.forename: Marc A
authors.initials: MA
authors.lastname: Bollet
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000379:methods; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D013318:Stroke Volume / Q000187:drug effects / Q000528:radiation effects; D000068878:Trastuzumab; D018487:Ventricular Dysfunction, Left / Q000209:etiology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab