Investigation of Association Between Cardiac Dose Distribution and Strain/Tissue Doppler Echocardiographic Indices Durin
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ORIGINAL ARTICLE
Investigation of Association Between Cardiac Dose Distribution and Strain/Tissue Doppler Echocardiographic Indices During 1-Year Post-Mastectomy Radiation Therapy Follow-Up in Breast Cancer Patients Soodabeh Shahidsales1 • Kazem Anvari1 • Seyed Alireza Javadinia2, • Fereshteh Ghaderi3 • Hamid Gholamhosseinian4 • Azar Fanipakdel1 • Mona Joudi1 • Nooshin Nazeminezhad5 • Zahra Sharifi6 Bahareh Jafarnejadi7
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Received: 30 April 2020 / Revised: 26 May 2020 / Accepted: 4 June 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Objective This study aimed to determine the association between cardiac dose distribution and strain and Tissue Imaging Doppler (TDI) echocardiographic indices during 1-year follow-up after Post-Mastectomy Radiotherapy (PMRT) in breast cancer patients. Methods and Materials In this prospective cohort study, patients with left breast cancer candidate for PMRT were included. The patients treated radiation dose of 50 Gy in 25 fractions over 5 weeks. Before the radiotherapy, and 6 and 12 months after it, the patients underwent echocardiography using strain and TDI methods. The changes in echocardiographic indices and their association with cardiac radiation dose were evaluated. Results In this study, 31 patients with mean age of 36.6 ± 4.6 years old and the cumulative doses of doxorubicin to 237 ± 5 mg/m2 were participated. Correlation between cardiac dose during radiotherapy and changes in strain and TDI echocardiographic indices showed a significant inverse relation between minimum cardiac dose and 6-month TAPSE changes (p = 0.04, r = - 0.3), maximum cardiac dose and 6-month RV strain changes (p = 0.04, r = - 0.3) and 6 and 12-month S0 changes (p = 0.02, r = - 0.4 and p = 0.05, r = - 0.3), Cardiac V30 with 6 and 12-month E velocity changes (p = 0.05, r = - 0.3 and p = 0.02, r = - 0.4, respectively) and Heart V20 with 12-month E velocity changes (p = 0.04, r = - 0.3). Normal RV strain observed before starting the study in 12 patients (38.7%) was found to be abnormal after 6-month follow-up (p = 0.004). Conclusion Results of this study showed that, PMRT was associated with left heart diastolic dysfunction and right heart systolic dysfunction especially in the first 6 months after radiotherapy. Keywords Breast cancer Mastectomy Adjuvant radiotherapy Cardiac dose Tissue Doppler imaging Strain
Introduction Breast cancer is the most common neoplasm among women, especially among women in their menopausal age [1]. Surgical mastectomy is main local treatment for breast
This prospective cohort study was carried out in two academic centers affiliated to Mashhad University of Medical Sciences including Omid and Imam Reza Educational Hospitals during 2016 to 2019.
cancer. Application of Post-Mastectomy Radiation Therapy (PMRT) following publication of the paper by EBCTCG (2005) is considered as a revolution in treatment of this disease and afterwards adjuvant chest wall radiotherapy has been considered as standard in NCCN guidelines. Paper published by EBCTCG (200
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