CARDIAC EFFECTS FOLLOWING ADJUVANT CHEMOTHERAPY AND BREAST IRRADIATION IN OPERABLE BREAST-CANCER

Aim: To assess the frequency and type of cardiac effects in women trea ted with adjuvant chemotherapy with or without breast irradiation for operable breast cancer. Patients and methods: Retrospective analysis o f a series of 825 women taking part in prospectively randomized trials on adjuvant chemotherapy with or without adriamycin (doxorubicin; Far mitalia-Carlo Erba, Milan, Italy) for operable breast cancer at high r isk of new disease manifestations. A total of 360 patients (44%) also received breast irradiation because of conservative surgery. Median fo llow-up in first clinical complete remission from end of all adjuvant treatments was 80 months. According to the protocol requirements, elec trocardiograms were obtained before breast cancer surgery, before star ting therapy with adriamycin and at the end of all adjuvant treatments . During the follow-up observation, electrocardiograms were systematic ally obtained at least once a year. In the presence of suspicious find ings as well as of clinical symptoms and signs of cardio-vascular dise ase, additional cardiac investigations were undertaken. However, percu taneous endomyocardial biopsies were never performed. Results: Congest ive heart failure occurred in a total of 4 women (0.5% of all patients ; 0.8% following adriamycin-containing chemotherapy; 2.6% after both a driamycin and irradiation to the left breast), in two of whom it was f atal. ST-segment and T-wave abnormalities in the absence of other symp toms and signs were detected in 3.4% of the case series. Other cardiac events were documented in 6.8% of all patients. Overall, cardiac effe cts were more frequently detected in women who received irradiation to the left breast. In addition, age greater than 55 years at surgery an d history of risk factors were important risk modifiers in the occurre nce of cardiac events. Conclusions: The addition of full-dose adriamyc in to alkylating-containing adjuvant chemotherapy, as given in our stu dies, failed per se to increase the frequency of cardiac effects. Thus anthracyclines, which have the potential to improve current treatment results, deserve a proper place in the design of future adjuvant stud ies.