Cardiac Events after Radiotherapy of the internal mammary chain by an exclusive 6 MV photon beam: A cohort from Epinal - CNRS - Centre national de la recherche scientifique Accéder directement au contenu
Communication Dans Un Congrès Année : 2010

Cardiac Events after Radiotherapy of the internal mammary chain by an exclusive 6 MV photon beam: A cohort from Epinal

Résumé

Purpose: For several months in 1999, the radiotherapy department of the Jean Monnet Hospital in inal (France) could not use electron beams during the dismantling of its second linear accelerator, and the installation of a new CLINAC 2100. During this time, the radiation therapy team decided to treat the internal mammary lymph node chain (IMC) of patients with breast cancer with a direct 6 MV photon beam energy, to deliver a dose of 50 Gy, instead of using mixed beams of photons and electrons. Materials: From February to June 1999, 37 patients had received an irradiation of IMC by a direct 6 MV photon beam during adjuvant radiotherapy for breast cancer. Seventeen of these patients received adjuvant chemotherapy with epirubicine, endoxan and 5FU. Following the report of a coronary disease event, this cohort was identified. The surviving patients were examined by a radiation oncologist and a cardiologist. They were offered a cardiac evaluation including an electrocardiogram, echocardiography, supplemented by a stress test or thallium scintigraphy if clinically required. Cardiac toxicity was evaluated according to the CTCAE v3 classification. Results: Among these 37 patients, 4 were lost to follow-up. After a median follow-up of 9 years, 24 patients had no cardiac complications, and 9 patients had serious cardiac events. Three patients experienced Grade 4 ischemic heart disease, one patient had a Grade 4 constrictive pericarditis, 3 patients developed Grade 4 valvular dysfunction, and 2 patients developed Grade 4 congestive heart failure. Seven patients died, but not from cardiac causes. In this cohort, the 9-year probability of developing Grade 4 cardiac event was 27%. Multivariate analysis showed that neither age (p = 0.20), nor chemotherapy (p = 0.33) nor cardiovascular risk factors were associated with the occurrence of cardiac events. Conclusions: Exclusive use of a direct 6 MV photon beam energy to irradiate the IMC during adjuvant radiotherapy for breast cancer exposes patients to an unacceptable increased risk of Grade 4 cardiac complications.
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Dates et versions

hal-00511696 , version 1 (25-08-2010)

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  • HAL Id : hal-00511696 , version 1

Citer

Jean-Marc Simon, François Renoult, Philippe Admant, Vincent Marchesi, Alain Noel, et al.. Cardiac Events after Radiotherapy of the internal mammary chain by an exclusive 6 MV photon beam: A cohort from Epinal. 29th Annual ESTRO Meeting (European Society for Therapeutic Radiology and Oncology), Sep 2010, Barcelone, Spain. pp.S129. ⟨hal-00511696⟩
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