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. 1997;76(7):943–945. doi: 10.1038/bjc.1997.489

Cardiotoxicity from intensive chemotherapy combined with radiotherapy in breast cancer.

H de Graaf 1, W V Dolsma 1, P H Willemse 1, W T van der Graaf 1, D T Sleijfer 1, E G de Vries 1, N H Mulder 1
PMCID: PMC2228075  PMID: 9328157

Abstract

Cardiac function was evaluated in 86 breast cancer patients after standard chemotherapy, followed by ablative chemotherapy and chest irradiation. One patient died of subacute heart failure 3 months after ablative chemotherapy. At a minimum of 1 year's follow-up (range 1-11 years) left vertricular ejection fraction (LVEF) was marginally abnormal in 4 of 27 disease-free survivors. One exceptional patient who received two transplantations is alive, with serious heart failure occurring after the second ablative chemotherapy. Including this patient, the percentage of patients free of clinical and subclinical cardiac dysfunction at 7 years is 78% (95% CI 61-95%). After ablative chemotherapy, cardiotoxicity was rarely life-threatening. The impact of subclinical cardiotoxicity in the long term is not clear and needs continued evaluation.

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Selected References

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  1. Bowers C., Adkins D., Dunphy F., Harrison B., LeMaistre C. F., Spitzer G. Dose escalation of mitoxantrone given with thiotepa and autologous bone marrow transplantation for metastatic breast cancer. Bone Marrow Transplant. 1993 Nov;12(5):525–530. [PubMed] [Google Scholar]
  2. Braverman A. C., Antin J. H., Plappert M. T., Cook E. F., Lee R. T. Cyclophosphamide cardiotoxicity in bone marrow transplantation: a prospective evaluation of new dosing regimens. J Clin Oncol. 1991 Jul;9(7):1215–1223. doi: 10.1200/JCO.1991.9.7.1215. [DOI] [PubMed] [Google Scholar]
  3. Cohen M., Kronzon I., Lebowitz A. Reversible doxorubicin-induced congestive heart failure. Arch Intern Med. 1982 Aug;142(8):1570–1571. [PubMed] [Google Scholar]
  4. Cornbleet M. A., Stuart-Harris R. C., Smith I. E., Coleman R. E., Rubens R. D., McDonald M., Mouridsen H. T., Rainer H., van Oosterom A. T., Smyth J. F. Mitoxantrone for the treatment of advanced breast cancer: single-agent therapy in previously untreated patients. Eur J Cancer Clin Oncol. 1984 Sep;20(9):1141–1146. doi: 10.1016/0277-5379(84)90122-6. [DOI] [PubMed] [Google Scholar]
  5. Cuzick J., Stewart H., Rutqvist L., Houghton J., Edwards R., Redmond C., Peto R., Baum M., Fisher B., Host H. Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol. 1994 Mar;12(3):447–453. doi: 10.1200/JCO.1994.12.3.447. [DOI] [PubMed] [Google Scholar]
  6. Druck M. N., Gulenchyn K. Y., Evans W. K., Gotlieb A., Srigley J. R., Bar-Shlomo B. Z., Feiglin D. H., McEwan P., Silver M. D., Millband L. Radionuclide angiography and endomyocardial biopsy in the assessment of doxorubicin cardiotoxicity. Cancer. 1984 Apr 15;53(8):1667–1674. doi: 10.1002/1097-0142(19840415)53:8<1667::aid-cncr2820530808>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  7. Gottdiener J. S., Appelbaum F. R., Ferrans V. J., Deisseroth A., Ziegler J. Cardiotoxicity associated with high-dose cyclophosphamide therapy. Arch Intern Med. 1981 May;141(6):758–763. [PubMed] [Google Scholar]
  8. Gyenes G., Fornander T., Carlens P., Rutqvist L. E. Morbidity of ischemic heart disease in early breast cancer 15-20 years after adjuvant radiotherapy. Int J Radiat Oncol Biol Phys. 1994 Mar 30;28(5):1235–1241. doi: 10.1016/0360-3016(94)90500-2. [DOI] [PubMed] [Google Scholar]
  9. John V., Müller R. D., Reiners C., Löhr E. Radiologisch-diagnostische Aspekte zu Späteffekten an den Thoraxorganen nach Chemo- und/oder Strahlentherapie sowie nach Behandlung mit Radionukliden. Strahlenther Onkol. 1988 Oct;164(10):619–628. [PubMed] [Google Scholar]
  10. McKillop J. H., Bristow M. R., Goris M. L., Billingham M. E., Bockemuehl K. Sensitivity and specificity of radionuclide ejection fractions in doxorubicin cardiotoxicity. Am Heart J. 1983 Nov;106(5 Pt 1):1048–1056. doi: 10.1016/0002-8703(83)90651-8. [DOI] [PubMed] [Google Scholar]
  11. Mulder N. H., Meinesz A. F., Sleijfer D. T., Postmus P. E., De Vries E. G., Van der Geest S., Orie J. L., Vriesendorp R. Feasibility of high dose VP 16-213 as single agent or in combination with cyclophosphamide and autologous bone marrow transplantation (ABMT). Neth J Med. 1984;27(10):389–392. [PubMed] [Google Scholar]
  12. Nielsen D., Jensen J. B., Dombernowsky P., Munck O., Fogh J., Brynjolf I., Havsteen H., Hansen M. Epirubicin cardiotoxicity: a study of 135 patients with advanced breast cancer. J Clin Oncol. 1990 Nov;8(11):1806–1810. doi: 10.1200/JCO.1990.8.11.1806. [DOI] [PubMed] [Google Scholar]
  13. Rhoden W., Hasleton P., Brooks N. Anthracyclines and the heart. Br Heart J. 1993 Dec;70(6):499–502. doi: 10.1136/hrt.70.6.499. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Rutqvist L. E., Lax I., Fornander T., Johansson H. Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys. 1992;22(5):887–896. doi: 10.1016/0360-3016(92)90784-f. [DOI] [PubMed] [Google Scholar]
  15. Saini J., Rich M. W., Lyss A. P. Reversibility of severe left ventricular dysfunction due to doxorubicin cardiotoxicity. Report of three cases. Ann Intern Med. 1987 Jun;106(6):814–816. doi: 10.7326/0003-4819-106-6-814. [DOI] [PubMed] [Google Scholar]
  16. Shapiro C. L., Henderson I. C. Late cardiac effects of adjuvant therapy: too soon to tell? Ann Oncol. 1994 Mar;5(3):196–198. doi: 10.1093/oxfordjournals.annonc.a058792. [DOI] [PubMed] [Google Scholar]
  17. Shenkenberg T. D., Von Hoff D. D. Mitoxantrone: a new anticancer drug with significant clinical activity. Ann Intern Med. 1986 Jul;105(1):67–81. doi: 10.7326/0003-4819-105-1-67. [DOI] [PubMed] [Google Scholar]
  18. Steinherz L. J., Steinherz P. G., Tan C. Cardiac failure and dysrhythmias 6-19 years after anthracycline therapy: a series of 15 patients. Med Pediatr Oncol. 1995 Jun;24(6):352–361. doi: 10.1002/mpo.2950240604. [DOI] [PubMed] [Google Scholar]
  19. Stewart J. R., Fajardo L. F., Gillette S. M., Constine L. S. Radiation injury to the heart. Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1205–1211. doi: 10.1016/0360-3016(94)00656-6. [DOI] [PubMed] [Google Scholar]
  20. Triozzi P. L., Rhoades C., Thornton D. E. High-dose chemotherapy for breast cancer. Cancer Treat Rev. 1995 May;21(3):185–198. doi: 10.1016/0305-7372(95)90000-4. [DOI] [PubMed] [Google Scholar]
  21. Tötterman K. J., Pesonen E., Siltanen P. Radiation-related chronic heart disease. Chest. 1983 Jun;83(6):875–878. doi: 10.1378/chest.83.6.875. [DOI] [PubMed] [Google Scholar]
  22. Valagussa P., Zambetti M., Biasi S., Moliterni A., Zucali R., Bonadonna G. Cardiac effects following adjuvant chemotherapy and breast irradiation in operable breast cancer. Ann Oncol. 1994 Mar;5(3):209–216. doi: 10.1093/oxfordjournals.annonc.a058795. [DOI] [PubMed] [Google Scholar]
  23. Von Hoff D. D., Layard M. W., Basa P., Davis H. L., Jr, Von Hoff A. L., Rozencweig M., Muggia F. M. Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med. 1979 Nov;91(5):710–717. doi: 10.7326/0003-4819-91-5-710. [DOI] [PubMed] [Google Scholar]
  24. de Graaf H., Willemse P. H., Sleijfer D. T., de Vries E. G., Van der Graaf W. T., Beukema J., Mulder N. H. Effective conditioning regimen for premenopausal patients with advanced breast cancer. Anticancer Res. 1994 Nov-Dec;14(6B):2799–2804. [PubMed] [Google Scholar]

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