title: Pre-operative cardiac workup after anthracycline-based neoadjuvant chemotherapy. Is it really necessary?
abstract: BACKGROUND
  In patients receiving pre-operative anthracyclines for locally advanced breast cancer, early cardiotoxicity is a well-recognised complication that may interfere with surgery. The aim of this study was to assess the safety of breast surgery after neoadjuvant treatment with  Doxorubicin.
  
  
  METHODS
  A retrospective study of breast cancer patients treated with Doxorubicin as part of their neoadjuvant protocol. All patients were subsequently operated in our institution. Intra-operative and postoperative haemodynamic, cardiac or respiratory events were  collected.
  
  
  RESULTS
  A total of 83 patients were included. All patients had a normal left ventricular ejection fraction before starting on chemotherapy. Doxorubicin was given in conjunction with Cyclophosphamide and Paclitaxel. The cumulative dose of Doxorubicin was 240 mg/m(2).  All patients completed their chemotherapy less than a year before surgery and were clinically asymptomatic. Of the patients, 2.3% displayed a significant reduction in cardiac function to meet cardiotoxicity criteria, although not clinically apparent. No complications occurred intra-operatively  or postoperatively.
  
  
  CONCLUSIONS
  Breast surgery can be safely performed after breast neoadjuvant chemotherapy with Doxorubicin. The risk of early cardiotoxicity does not mandate a cardiac function assessment after completion of treatment. Work-up should be individualised according to the  anthracycline regimen, patient's cardiac risk factors and functional status before surgery.
authors.affiliation: Department of Surgical Oncology, Chaim Sheba Medical Center, Tel-Hashomer, Israel. ronash@gmail.com
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
authors.forename: Daphna
authors.initials: D
authors.lastname: Barsuk
authors.forename: Lior
authors.initials: L
authors.lastname: Segev
authors.forename: Shani
authors.initials: S
authors.lastname: Shimon-Paluch
authors.forename: Haim
authors.initials: H
authors.lastname: Berkenstadt
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Zippel
authors.forename: Moshe Z
authors.initials: MZ
authors.lastname: Papa
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin