Late cardiopulmonary complications in breast cancer patients followingcombined adjuvant treatment

A i m. The aim of the study was to evaluate late toxicity from heart and lungs in breast cancer patients treated with mastectomy and adjuvant sequential chemotherapy and radiotherapy (Chth and Rt). Material and methods . Forty seven women (mean age 47 years) with stage T1-4N0-2 M0 breast cancer, treated with mastectomy and adjuvant sequential chemotherapy and radiotherapy were examined in order to assess the side-effects in the heart and the lungs. All patients underwent chemotherapy: 40 received chemotherapy including antracyclines, 7- without antracyclines. Radiotherapy was undertaken in all cases. It was administered after chemotherapy and was planned according to the well-established technique. It included the chest wall and regional lymph nodes with a specified dose of 46-50 Gy administered in daily fractions of 2Gy. The high resolution computed tomography HRCT of the lungs was performed after a mean time of 17 (13-28) months and then, after a mean time of 33 (28-58) months. The condition of the heart was studied using electrocardiography (ECG) and echocardiography (ECHO), which were performed before combined treatment and then after a mean time of 17 and 33 months from its completion. Results . Heart: 7 patients had an abnormal echocardiogram (ventricular dilatation, abnormal Left Ventricular Ejection Fraction, disordered left ventricular contractility, worsening of pre-existent valvular disease). All 7 had received chemotherapy including antracyclines. In 5 of them the echocardiographic defects were asymptomatic and reversible during the time of observation. In 2 patients moderate toxicity was observed. The analysis of isodose distribution excluded radiotherapy as a factor influencing toxicity, but seems to indicate a connection with antracyclines. Lungs: The first examination (after a mean time of 17 months) revealed no changes in 24 patients. There were 19 fibrotic changes in lung apex and 19 cases of parietal fibrosis. In the second examination (after a mean time of 33 months), there were no changes in 24 patients and 22 fibrotic changes in lung apex and 13 cases of parietal fibrosis. All these changes were discrete, asymptomatic and the parietal fibrosis was invisible in the chest X-rays. The analysis of the evolution of fibrotic changes revealed that parietal fibrosis had a tendency to regression, but the apical ones are unpredictable: some of them do regress, but others – progress. The probability of parietal fibrosis did not depended on type of chemotherapy (p=0.64), but significantly depended on the depth of 50% isodose in the lung (p<0.05). Conclusions . Postoperative radiotherapy as an element of combined adjuvant treatment in breast cancer, administered in conventional fractionated doses, causes no clinically significant lesions in the lungs and heart. The analysis of the distribution of isodoses in the heart showed, that clinically important myocardial changes, observed in two patients, were not connected with radiotherapy. Probably, they were connected with epirubicin chemotherapy. Correctly planned postoperative radiotherapy is a safe therapeutic method causing no significant disturbances of the functions of vital organs during the mean follow-up period of 33 months.