Clinical Research Papers:

Early cardiac toxicity following adjuvant radiotherapy of left-sided breast cancer with or without concurrent trastuzumab

Lu Cao, Gang Cai, Cai Chang, Zhao-Zhi Yang, Yan Feng, Xiao-Li Yu, Jin-Li Ma, Jiong Wu, Xiao-Mao Guo and Jia-Yi Chen _

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Oncotarget. 2016; 7:1042-1054. https://doi.org/10.18632/oncotarget.6053

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Lu Cao1,4,5, Gang Cai1,4,5, Cai Chang2,5, Zhao-Zhi Yang1,5, Yan Feng1,5, Xiao-Li Yu1,5, Jin-Li Ma1,5, Jiong Wu3,5, Xiao-Mao Guo1,5 and Jia-Yi Chen1,4,5

1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

2 Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China

3 Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

4 Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

5 Shanghai Medical College, Fudan University, Shanghai, China

Correspondence to:

Jia-Yi Chen, email:

Keywords: breast cancer, cardiotoxicity, radiotherapy, trastuzumab, concurrent treatment

Received: May 24, 2015 Accepted: September 23, 2015 Published: October 09, 2015


Purpose: To evaluate the influence of concurrent trastuzumab on the cardiotoxicity in patients receiving left-sided adjuvant radiotherapy.

Materials and Methods: Medical records of stage I-III left-sided breast cancer patients, including 64 receiving concurrent trastuzumab with radiotherapy and 73 receiving radiotherapy alone were retrospectively reviewed. All of the patients had normal LVEF after adjuvant chemotherapy. Information of doses volume to cardiac structures was collected. Cardiac events were assessed according to CTC 2.0.

Results: Median follow-up of LVEF and clinical assessment of cardiac function from the initiation of radiotherapy was 6.7 months (range 3–60.9) and 26 months (range 6.4–60.9), respectively. Grade 1 LVEF dysfunction occurred in 5 (7.8%) and 3 (4.1%) patients of the concurrent-trastuzumab and radiotherapy alone cohort, respectively. Trastuzumab was the only significant factor influencing absolute LVEF decrease in univariate analysis. In multivariate analysis of concurrent-trastuzumab cohort, IMC radiotherapy and start trastuzumab during radiotherapy were independent risk factors. For concurrent cohort, mean heart dose, as well as D10-D30, D50-D55, V5-V20 of the heart and D30-D45, D65-D75, V6-V15 of the LV were significantly higher in patients developing LVEF dysfunction.

Conclusions: Concurrent trastuzumab and left-sided radiotherapy is well tolerated in terms of cardiotoxicity in patients with normal baseline cardiac function after adjuvant chemotherapy. However, increases in mean dose and low–dose volume of cardiac structures are associated with a higher risk of acute LVEF dysfunction.

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