Equilibrium radionuclide ventriculography in the assessment of cardiotoxicity of chemotherapy and chemoradiotherapy in patients with breast cancer

Abstract

BACKGROUND: Multidrug chemotherapy increases the efficacy of the treatment, but at the same time rises its cardiotoxicity. The majority of cardiac complications are caused by anthracyclines. Radiation therapy may intensify cardiotoxicity. The aim of this study was to determine early changes of cardiac function using radionuclide ventriculography in patients with breast cancer and to compare the toxicity of AC and AT chemotherapy programs. MATERIAL AND METHODS: The study included 71 patients with breast cancer between the ages of 38 and 71 years. All patients after surgery were qualified for chemotherapy, and for 37 (52%) of them subsequent irradiation treatment was planned. Patients received chemotherapy according to the scheme: AC-47 patients (66%) and AT-24 patients (34%). Patients were irradiated using a photon beam (4 to 6 MeV) and an electron Equilibrium radionuclide ventriculography in the assessment of cardiotoxicity of chemotherapy and chemoradiotherapy in patients with breast cancer

The role of general nuclear medicine in breast cancer

“…[52][53][54] Among the rapidly increasing variety of anti-cancer drugs used in breast cancer treatment, the anthracyclines and the monoclonal antibody trastuzumab, are the agents with well-known cardiotoxicity. 53,55 Anthracycline chemotherapy causes cumulative dose-dependent cardiotoxicity with direct and irreversible cellular damage to myocytes, which can result in congestive heart failure and even cardiac death. 52 Trastuzumab can induce high cardiotoxicity rates particularly when combined with anthracyclines.…”

“…52 Evaluation of global LV systolic function and diastolic performance indexes using RNA has proven effective for early assessment of functional changes after chemotherapy compared to baseline, emphasising that serial imaging is critical at all treatment stages to assess patient prognosis. 53,59 A reduction in the peak fill rate as measured by multigated RNA indicates worsening diastolic function, a parameter that is often impaired before declining systolic function in anthracycline-induced cardiotoxicity and more importantly, is an early indication of compromised cardiac function. 56,63 Small or moderate cases of pericardial effusions do not compromise LVEF but may induce comorbidities such as compromised breathing, induced chest pain and abdominal fullness, and difficulty swallowing.…”

“…It is well documented across cancer research that the use of multidrug chemotherapy induces cardiac abnormalities and requires routine monitoring of left ventricular ejection fraction. [52][53][54] Among the rapidly increasing variety of anti-cancer drugs used in breast cancer treatment, the anthracyclines and the monoclonal antibody trastuzumab, are the agents with well-known cardiotoxicity. 53,55 Anthracycline chemotherapy causes cumulative dose-dependent cardiotoxicity with direct and irreversible cellular damage to myocytes, which can result in congestive heart failure and even cardiac death.…”

“…52,54 Radiation-induced heart disease such as coronary artery disease, valvular disease, constructive pericarditis and myocardial dysfunction including congestive heart failure can significantly limit a patient's quality of life. 52,53,58 Thus, it is imperative to effectively ascertain the extent of a patient's risk for a cardiac event. The standard method to detect cardiotoxicity and pericardial effusions is acquiring ejection fraction measurements performed prior to and post-chemotherapy treatment in breast cancer patients.…”

“…62 To visualise all left ventricular wall segments, positioning for planar acquisition includes anterior, lateral, and left anterior oblique (LAO) views with a caudal tilt to best isolate the left ventricle from the left atrium and facilitate accurate processing. 53,56 Using electrocardiogram leads, images are simultaneously registered with the patient's gated heartbeat to evaluate regional left ventricular wall motion and contractility. 59 The final result is a series of cine images of the heart that provide a map of sequential contractions or phase imaging to precisely quantify left ventricular volume and visually assess dyssynchrony.…”