Top

Published in:

01-07-2017 | Review

Early cardiac perfusion defects after left-sided radiation therapy for breast cancer: is there a volume response?

Authors: Orit Kaidar-Person, Timothy M. Zagar, Jorge Daniel Oldan, Jason Matney, Ellen L. Jones, Shiva Das, Brian C. Jensen, Richard C. Zellars, Terence Z. Wong, Lawrence B. Marks

Published in: Breast Cancer Research and Treatment | Issue 2/2017

Abstract

Purpose

Cardiac single-photon emission computed tomography (SPECT) is often used to identify defects in myocardial perfusion due to atherosclerotic coronary artery disease. It was also used in studies to evaluate radiation therapy (RT)-associated cardiac abnormalities. In the current review, we aim to evaluate the rates of post-RT cardiac SPECT early perfusion abnormalities and relate this to the irradiated left ventricular volume.

Methods

The studies cited in this systematic review were identified using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Results

Six studies between 1996 and 2016 fulfilled the inclusion criteria. The reported perfusion defects in these studies were seen in the apical and anterolateral aspects of the left ventricle. Three studies show correlation between the percent of the left ventricle within the RT-field and percent of patients with early perfusion defects on cardiac SPECT. In two studies that used cardiac sparing techniques (such as deep inspiration), that resulted in a low mean heart dose, no perfusion defects were noted.

Conclusions

Data suggest that incidental irradiation of the heart in cases of left breast/chest wall RT can result in early post-RT perfusion defects on cardiac SPECT. There appears to be strong dose/volume dependence to the risk, and hence techniques to reduce cardiac exposure are recommended.

Available only for authorised users

Lin GS, Hines HH, Grant G, Taylor K, Ryals C (2006) Automated quantification of myocardial ischemia and wall motion defects by use of cardiac SPECT polar mapping and 4-dimensional surface rendering. J Nucl Med Technol 34(1):3–17PubMed

Groarke JD, Nguyen PL, Nohria A, Ferrari R, Cheng S, Moslehi J (2014) Cardiovascular complications of radiation therapy for thoracic malignancies: the role for non-invasive imaging for detection of cardiovascular disease. Eur Heart J 35(10):612–623CrossRefPubMed

Das SK, Chen S, Deasy JO, Zhou S, Yin FF, Marks LB (2008) Combining multiple models to generate consensus: application to radiation-induced pneumonitis prediction. Med Phys 35(11):5098–5109CrossRefPubMedPubMedCentral

Correa CR, Das IJ, Litt HI, Ferrari V, Hwang WT, Solin LJ, Harris EE (2008) Association between tangential beam treatment parameters and cardiac abnormalities after definitive radiation treatment for left-sided breast cancer. Int J Radiat Oncol Biol Phys 72(2):508–516CrossRefPubMed

Das SK, Baydush AH, Zhou S, Miften M, Yu X, Craciunescu O, Oldham M, Light K, Wong T, Blazing M et al (2005) Predicting radiotherapy-induced cardiac perfusion defects. Med Phys 32(1):19–27CrossRefPubMed

Evans ES, Prosnitz RG, Yu X, Zhou SM, Hollis DR, Wong TZ, Light KL, Hardenbergh PH, Blazing MA, Marks LB (2006) Impact of patient-specific factors, irradiated left ventricular volume, and treatment set-up errors on the development of myocardial perfusion defects after radiation therapy for left-sided breast cancer. Int J Radiat Oncol Biol Phys 66(4):1125–1134CrossRefPubMed

Sioka C, Exarchopoulos T, Tasiou I, Tzima E, Fotou N, Capizzello A, Ragos V, Tsekeris P, Fotopoulos A (2011) Myocardial perfusion imaging with (99 m)Tc-tetrofosmin SPECT in breast cancer patients that received postoperative radiotherapy: a case-control study. Radiat Oncol 6:151CrossRefPubMedPubMedCentral

Chung E, Corbett JR, Moran JM, Griffith KA, Marsh RB, Feng M, Jagsi R, Kessler ML, Ficaro EC, Pierce LJ (2013) Is there a dose-response relationship for heart disease with low-dose radiation therapy? Int J Radiat Oncol Biol Phys 85(4):959–964CrossRefPubMed

Lind PA, Pagnanelli R, Marks LB, Borges-Neto S, Hu C, Zhou SM, Light K, Hardenbergh PH (2003) Myocardial perfusion changes in patients irradiated for left-sided breast cancer and correlation with coronary artery distribution. Int J Radiat Oncol Biol Phys 55(4):914–920CrossRefPubMed

10.

Yu X, Prosnitz RR, Zhou S, Hardenberg PH, Tisch A, Blazing MA, Borges-Neto S, Hollis D, Wong T, Marks LB (2003) Symptomatic cardiac events following radiation therapy for left-sided breast cancer: possible association with radiation therapy-induced changes in regional perfusion. Clin Breast Cancer 4(3):193–197PubMed

11.

Zellars R, Bravo PE, Tryggestad E, Hopfer K, Myers L, Tahari A, Asrari F, Ziessman H, Garrett-Mayer E (2014) SPECT analysis of cardiac perfusion changes after whole-breast/chest wall radiation therapy with or without active breathing coordinator: results of a randomized phase 3 trial. Int J Radiat Oncol Biol Phys 88(4):778–785CrossRefPubMed

12.

Gyenes G, Fornander T, Carlens P, Glas U, Rutqvist LE (1997) Detection of radiation-induced myocardial damage by technetium-99 m sestamibi scintigraphy. Eur J Nucl Med 24(3):286–292PubMed

13.

Gyenes G, Fornander T, Carlens P, Glas U, Rutqvist LE (1996) Myocardial damage in breast cancer patients treated with adjuvant radiotherapy: a prospective study. Int J Radiat Oncol Biol Phys 36(4):899–905CrossRefPubMed

14.

Zagar TM, Cardinale DM, Marks LB (2016) Breast cancer therapy-associated cardiovascular disease. Nat Rev Clin Oncol 13(3):172–184CrossRefPubMed

15.

Eftekhari M, Anbiaei R, Zamani H, Fallahi B, Beiki D, Ameri A, Emami-Ardekani A, Fard-Esfahani A, Gholamrezanezhad A, Seid Ratki KR et al (2015) Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy. Asia Ocean J Nucl Med Biol 3(1):3–9PubMedPubMedCentral

16.

Marks LB, Yu X, Prosnitz RG, Zhou SM, Hardenbergh PH, Blazing M, Hollis D, Lind P, Tisch A, Wong TZ et al (2005) The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys 63(1):214–223CrossRefPubMed

17.

Zagar TM, Kaidar-Person O, Tang X, Jones EE, Matney J, Das SK, Green RL, Sheikh A, Khandani AH, McCartney WH et al (2017) Utility of deep inspiration breath hold for left-sided breast radiation therapy in preventing early cardiac perfusion defects: a prospective study. Int J Radiat Oncol Biol Phys 97(5):903–909CrossRefPubMed

18.

Early Breast Cancer Trialists’ Collaborative Group, Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716CrossRef

19.

Ebctcg McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, Gray R, Mannu G, Peto R et al (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 383(9935):2127–2135CrossRef

20.

Burstein HJ, Griggs JJ, Prestrud AA, Temin S (2010) American society of clinical oncology clinical practice guideline update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Oncol Pract 6(5):243–246CrossRefPubMedPubMedCentral

21.

McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM, Fornander T, Gigante B, Jensen MB, Peto R et al (2011) Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol 100(2):167–175CrossRefPubMed

22.

Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Bronnum D, Correa C, Cutter D, Gagliardi G, Gigante B et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368(11):987–998CrossRefPubMed

23.

Darby SC, Cutter DJ, Boerma M, Constine LS, Fajardo LF, Kodama K, Mabuchi K, Marks LB, Mettler FA, Pierce LJ et al (2010) Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys 76(3):656–665CrossRefPubMedPubMedCentral

24.

Cuzick J, Stewart H, Rutqvist L, Houghton J, Edwards R, Redmond C, Peto R, Baum M, Fisher B, Host H et al (1994) Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol 12(3):447–453CrossRefPubMed

25.

Taylor CW, Bronnum D, Darby SC, Gagliardi G, Hall P, Jensen MB, McGale P, Nisbet A, Ewertz M (2011) Cardiac dose estimates from Danish and Swedish breast cancer radiotherapy during 1977-2001. Radiother Oncol 100(2):176–183CrossRefPubMedPubMedCentral

26.

Gagliardi G, Constine LS, Moiseenko V, Correa C, Pierce LJ, Allen AM, Marks LB (2010) Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 76(3 Suppl):S77–S85CrossRefPubMed

27.

Bradley JD, Paulus R, Komaki R, Masters G, Blumenschein G, Schild S, Bogart J, Hu C, Forster K, Magliocco A et al (2015) Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol 16(2):187–199CrossRefPubMedPubMedCentral

28.

van Nimwegen FA, Schaapveld M, Cutter DJ, Janus CP, Krol AD, Hauptmann M, Kooijman K, Roesink J, van der Maazen R, Darby SC et al (2016) Radiation dose-response relationship for risk of coronary heart disease in survivors of hodgkin lymphoma. J Clin Oncol 34(3):235–243CrossRefPubMed

29.

Seddon B, Cook A, Gothard L, Salmon E, Latus K, Underwood SR, Yarnold J (2002) Detection of defects in myocardial perfusion imaging in patients with early breast cancer treated with radiotherapy. Radiother Oncol 64(1):53–63CrossRefPubMed

30.

Cowen D, Gonzague-Casabianca L, Brenot-Rossi I, Viens P, Mace L, Hannoun-Levi JM, Alzieu C, Resbeut M (1998) Thallium-201 perfusion scintigraphy in the evaluation of late myocardial damage in left-side breast cancer treated with adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 41(4):809–815CrossRefPubMed

31.

Hojris I, Overgaard M, Christensen JJ, Overgaard J (1999) Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Radiotherapy Committee of the Danish Breast Cancer Cooperative Group. Lancet 354(9188):1425–1430CrossRefPubMed

32.

Gustavsson A, Bendahl PO, Cwikiel M, Eskilsson J, Thapper KL, Pahlm O (1999) No serious late cardiac effects after adjuvant radiotherapy following mastectomy in premenopausal women with early breast cancer. Int J Radiat Oncol Biol Phys 43(4):745–754CrossRefPubMed

33.

Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, Vallis KA, White JR, Rousseau P, Fortin A et al (2015) Regional nodal irradiation in early-stage breast cancer. N Engl J Med 373(4):307–316CrossRefPubMedPubMedCentral

34.

Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, Collette L, Fourquet A, Maingon P, Valli M et al (2015) Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 373(4):317–327CrossRefPubMed

35.

Thorsen LB, Offersen BV, Dano H, Berg M, Jensen I, Pedersen AN, Zimmermann SJ, Brodersen HJ, Overgaard M, Overgaard J (2016) DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol 34(4):314–320CrossRefPubMed

36.

Raj KA, Evans ES, Prosnitz RG, Quaranta BP, Hardenbergh PH, Hollis DR, Light KL, Marks LB (2006) Is there an increased risk of local recurrence under the heart block in patients with left-sided breast cancer? Cancer J 12(4):309–317CrossRefPubMed

37.

Taylor CW, Wang Z, Macaulay E, Jagsi R, Duane F, Darby SC (2015) Exposure of the heart in breast cancer radiation therapy: a systematic review of heart doses published during 2003 to 2013. Int J Radiat Oncol Biol Phys 93(4):845–853CrossRefPubMed

38.

Blitzblau R, Wright A, Arya R, Broadwater G, Pura J, Hardenbergh PH, Borges-Neto S, Wong TZ, Marks LB, Horton JK (2015) Are long-term cardiac outcomes predicted by short-term postradiation cardiac perfusion deficits: an 8–15 year follow-up of a prospective Study. Int J Radiat Oncol Biol Phys 93(3):S106–S107CrossRef

39.

Taylor CW, Nisbet A, McGale P, Darby SC (2007) Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int J Radiat Oncol Biol Phys 69(5):1484–1495CrossRefPubMed

Title: Early cardiac perfusion defects after left-sided radiation therapy for breast cancer: is there a volume response?
Authors: Orit Kaidar-Person
Timothy M. Zagar
Jorge Daniel Oldan
Jason Matney
Ellen L. Jones
Shiva Das
Brian C. Jensen
Richard C. Zellars
Terence Z. Wong
Lawrence B. Marks
Publication date: 01-07-2017
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 2/2017
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-017-4248-y

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2017

The role of quantitative estrogen receptor status in predicting tumor response at surgery in breast cancer patients treated with neoadjuvant chemotherapy

Abbreviated breast dynamic contrast-enhanced MR imaging for lesion detection and characterization: the experience of an Italian oncologic center

Objective breast symmetry analysis with the breast analyzing tool (BAT): improved tool for clinical trials

The Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaLuAtion (UMBRELLA): objectives, design, and baseline results

Effects of metformin versus placebo on vitamin B12 metabolism in non-diabetic breast cancer patients in CCTG MA.32

Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia

Keynote webinar | Spotlight on antibody–drug conjugates in cancer