B20
Concurrent trastuzumab and radiotherapy retrospective single institution study of acute cardiac toxicity
Olivia Hatcher, Mausam Singhera, Pippa Riddle
Imperial College Healthcare NHS Trust, London, UK
Aim
To examine acute cardiac toxicity of concurrent breast radiotherapy and trastuzumab
Method
Clinical and cardiac data were collected on all patients who received adjuvant radiotherapy and Trastuzumab after chemotherapy for early breast cancer at Charing Cross Hospital between January 2006 and December 2008.
Results
Of the 91 eligible patients, cardiac data was available for 82 patients with median follow up of 19 months. 46 patients had left sided tumours and 45 had right sided. Median age was 51 years. 90 patients had adjuvant chemotherapy. All patients were treated with standard breast tangents without internal mammary chain radiation to a dose of 50 Gy/25# (35) or 40.05/15# (56). 51 patients received Trastuzumab concurrently, 24 (left) and 27 (right) and 40 sequentially.
There was no significant difference in the median post treatment LVEF between the concomitant and sequential groups (64% and 60% respectively) using ANOVA analysis. Overall Grade1 LVEF toxicity was seen in 7.6% (7) patients and Grade 2 in 2.1% (2). In the concomitant group, 7.8% (3 left, 1 right) had Grade 1 LVEF toxicity and none had Grade 2 toxicity. 3 patients had Trastuzumab discontinued due to cardiac causes (1 Left concomitant and 2 sequential).The final median LVEF of patients treated concomitantly with 40.05Gy/15# was 64%, which did not differ from those who received 50Gy/25#.
Conclusion
Concurrent radiotherapy and trastuzumab is safe in the adjuvant treatment of early breast cancer. Hypo fractionated schedules do not seem to contribute to cardiac toxicity. Concurrent treatment will shorten the overall duration of adjuvant treatment and hopefully increase local control in this group of patients by increased radiosensitivity and radiation induced apoptosis.
