Electrocardiographic Changes After Radiation Therapy for Carcinoma of the Breast Incidence and functional significance

Lindahl, J; Strender, Lars-Erik; Larsson, Lars‐Erik; Unsgaard, A

doi:10.3109/02841868309135967

Cited by 20 publications

(10 citation statements)

References 14 publications

(1 reference statement)

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“… 16 , 23 The timing of imaging in one study was before, during, and after (ie, before each cycle, then 2, 4, 7, and 12–18 months after) chemotherapy, 16 while, in the other study, imaging was a one-time assessment in long-term follow-up to chemotherapy treatment (mean follow-up of 34 months). 23 Stress ECG was utilized in five studies: one demonstrated a benefit, 22 although the benefit in this study was attributed to stress SPECT, not ECG; two demonstrated possible benefit, 19 , 27 and two no benefit. 17 , 20 Stress ventriculography was used in one study and demonstrated a benefit, compared to testing performed at rest; 26 while stress cMRI was also used in one study and failed to show a benefit, relative to resting imaging.…”

Section: Resultsmentioning

confidence: 91%

“…Overall, five studies 16 , 22 , 23 , 25 , 26 showed a benefit, five 18 , 19 , 24 , 27 , 28 showed possible benefit, and four 17 , 20 , 21 , 29 showed no benefit to utilizing cardiac stress tests in identifying evidence of cardiovascular disease in breast cancer survivors.…”

Section: Resultsmentioning

confidence: 94%

“…Heart function tests that were performed with stress in the selected studies were scintigraphy (n=5), 17 , 19 , 20 , 28 , 29 single photon emission computed tomography (SPECT) (n=4), 18 , 22 , 24 , 25 echocardiography (n=2), 16 , 23 cardiac magnetic resonance imaging (cMRI) (n=1), 21 nuclear ventriculography (n=1), 26 and ECG (n=5). 17 , 19 , 20 , 22 , 27 The utility of stress among each technique is shown in Figure 2A .…”

Section: Resultsmentioning

confidence: 99%

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The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review

Kirkham¹,

Virani²,

Campbell³

2015

IJWH

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BackgroundHeart function tests performed with myocardial stress, or “cardiac stress tests”, may be beneficial for detection of cardiovascular disease. Women who have been diagnosed with breast cancer are more likely to develop cardiovascular diseases than the general population, in part due to the direct toxic effects of cancer treatment on the cardiovascular system. The aim of this review was to determine the utility of cardiac stress tests for the detection of cardiovascular disease after cardiotoxic breast cancer treatment.DesignSystematic review.MethodsMedline and Embase were searched for studies utilizing heart function tests in breast cancer survivors. Studies utilizing a cardiac stress test and a heart function test performed at rest were included to determine whether stress provided added benefit to identifying cardiac abnormalities that were undetected at rest within each study.ResultsFourteen studies were identified. Overall, there was a benefit to utilizing stress tests over tests at rest in identifying evidence of cardiovascular disease in five studies, a possible benefit in five studies, and no benefit in four studies. The most common type of stress test was myocardial perfusion imaging, where reversible perfusion defects were detected under stress in individuals who had no defects at rest, in five of seven studies of long-term follow-up. Two studies demonstrated the benefit of stress echocardiography over resting echocardiography for detecting left ventricular dysfunction in anthracycline-treated breast cancer survivors. There was no benefit of stress cardiac magnetic resonance imaging in one study. Two studies showed a potential benefit of stress electrocardiography, whereas three others did not.ConclusionThe use of cardiac stress with myocardial perfusion imaging and echocardiography may provide added benefit to tests performed at rest for detection of cardiovascular disease in breast cancer survivors, and merits further research.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review

Kirkham¹,

Virani²,

Campbell³

2015

IJWH

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“…These changes present greater magnitude in the precordial derivations. 36 changes to the carotid arteries and other vessels An increased risk of stroke secondary to carotid artery disease has been reported in patients with a history of cervical irradiation, especially when it occurs at an age group in which the atherosclerotic disease of the carotid artery would not be expected. 15,37 A study that used a duplex scan of the carotid arteries in patients between 18 and 37 years of age who received cervical RT due Hodgkin's lymphoma, all in remission and asymptomatic, with more than five years since the end of treatment compared with a control group of healthy and age-matched volunteers identified focal or generalized abnormalities of the intima-media layer (26% in the study group versus 3% in the control group), such as fatty streaks, irregularities and discontinuities in the layers, microcalcifications, graininess and initial plaques smaller than 2 mm of common carotids and proximal internal sections of the carotid artery.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Cardiovascular effects of radiotherapy on the patient with cancer

Moreira

Silva²,

Ribeiro³

et al. 2016

Rev. Assoc. Med. Bras.

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Summary The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presentes a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals. Injuries caused by RT include diseases of the pericardium, coronary artery disease, valvular disease, myocardial disease with systolic and diastolic dysfunction, conduction disorders, and carotid artery and great vessels disease. Thoracic and cervical irradiation increases cardiovascular morbidity and mortality. Despite the great progress in the improvement of RT techniques, totally excluding prime areas of the cardiovascular system from the irradiation field is not yet possible. Guidelines must be created for monitoring, diagnosis and treatment of patients with CA treated with RT.

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“…(12) D5 was also chosen because there is evidence that a small volume of heart exposed to large doses of radiation can result in significant cardiac complications. (11,13) The difference in fraction size is another factor that should be considered when comparing dose parameters between PBI and WBI. The treatment regimens used in the protocol are a daily dose of 1.8 to 2.0 Gy for 25 to 35 fractions for WBI, compared with a PBI external beam dose of 3.85 Gy per fraction for 10 fractions.…”

mentioning

confidence: 99%

Cardiac dose evaluation for 3Dimensional conformal partial breast irradiation compared with whole breast irradiation

Gale

Jain

Vallow

et al. 2009

J Applied Clin Med Phys

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To compare the radiation dose to normal cardiac tissue for 3Dimensional (3D) conformal external beam partial breast irradiation (PBI) and standard whole breast irradiation (WBI), and examine the effect of tumor bed location.For 14 patients with left breast tumors randomized on the National Surgical Adjuvant Breast and Bowel Project B‐39 protocol, computer‐generated radiotherapy treatment plans were devised for WBI and PBI. Tumor bed location was designated according to whether more than 50% of the excision cavity was medial or lateral to the nipple line. The volume of heart receiving doses of 2.5, 5, 10, and 20 Gy was calculated for all PBI and WBI plans. Dose to 5% of the heart volume (D5) and mean heart dose were also calculated. The biologically‐equivalent dose (BED) was calculated to account for the different fractionation used in PBI and WBI.Of the 14 patients, 8 had lateral tumor beds, and 6 had medial tumor beds. The volumes of heart receiving 2.5, 5, 10, and 20 Gy were significantly lower for lateral PBI compared with WBI. For medial PBI, significant cardiac sparing was only seen at a dose of 20 Gy. The difference of D5 values was significant for lateral PBI compared with WBI (p=0.008), but not for medial PBI compared with WBI (p=0.84). The mean dose was also significantly lower for lateral PBI compared with WBI (p=0.008), but not for medial PBI (p=0.16). The results from BED calculations did not change this outcome.Both 3D conformal PBI and standard WBI can deliver relatively low doses to the heart. For patients with lateralized tumor beds, PBI offers significant cardiac sparing compared with WBI. Patients with medial lesions have relatively similar heart dosimetry with PBI and WBI. 3D conformal PBI is an emerging treatment modality and continued participation on clinical trials is encouraged. Patients with left‐sided lesions and lateralized tumor beds warrant special consideration for PBI, given the significant cardiac dose sparing.PACS numbers: 87.53.Tf

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Electrocardiographic Changes After Radiation Therapy for Carcinoma of the Breast Incidence and functional significance

Cited by 20 publications

References 14 publications

The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review

The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review

Cardiovascular effects of radiotherapy on the patient with cancer

Cardiac dose evaluation for 3Dimensional conformal partial breast irradiation compared with whole breast irradiation

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