Original Contribution| Volume 4, ISSUE 3, P193-197, August 2003

Symptomatic Cardiac Events Following Radiation Therapy for Left-Sided Breast Cancer: Possible Association with Radiation Therapy—Induced Changes in Regional Perfusion

      This paper is only available as a PDF. To read, Please Download here.


      Our group has demonstrated that tangential radiation therapy (RT) to the left breast or chest wall can cause perfusion changes in the anterior myocardium. We assess if RT-induced perfusion changes are associated with the development of symptoms consistent with cardiac dysfunction. Between 1998 and 2001, 114 patients were enrolled into an institutional review board—approved prospective study and had pre-RT and serial post-RT (range, 6-24 months) single photon emission computed tomography (SPECT) scans to assess changes in regional cardiac perfusion. Thirty-one patients were excluded. The incidence of cardiac symptoms in patients with and without RT-induced perfusion defects was compared using a 2-tailed Fisher's exact test. With a median follow-up of 16 months (range, 6-24 months), 10 of 83 evaluable patients had ≥ 1 episode of transient chest pain, occurring 0-14 months after RT (median, 6 months). The rates of chest pain in the patients with and without new perfusion defects were 9 of 31 and 1 of 52, respectively (P = 0.0004). A similar result was found when patients were segregated based on the use of chemotherapy. Two of these 10 cases were diagnosed as pericarditis. No patient had myocardial infarction or congestive heart failure. Cardiac symptoms occur more frequently in patients with perfusion abnormalities by SPECT after RT than in patients with normal SPECT scans, suggesting that such perfusion defects may be clinically significant. One confounding factor is that women who know they have RT-induced perfusion defects may be more likely to report episode of chest pain. Long-term follow-up will be necessary to better assess the clinical significance of RT-induced perfusion defects.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ragaz J
        • Jackson SM
        • Le N
        • et al.
        Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer.
        N Engl J Med. 1997; 337: 956-962
        • Overgaard M
        • Hansen PS
        • Overgaard J
        • et al.
        Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomized trial.
        Lancet. 1999; 353: 1641-1648
        • Overgaard M
        • Hansen PS
        • Overgaard J
        • et al.
        Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy.
        N Engl J Med. 1997; 337: 949-955
        • Jacobson JA
        • Danforth DN
        • Cowan KH
        • et al.
        Ten-year results of a comparison of conservation with mastectomy in the treatment of stage II and I breast cancer.
        New Engl J Med. 1995; 332: 907-911
        • Cuzick J
        • Stewart H
        • Peto R
        • et al.
        Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer.
        Cancer Treat Rep. 1987; 71: 15-25
        • Cuzick J
        • Stewart H
        • Peto R
        • et al.
        Overview of randomized trials comparing radical mastectomy without radiotherapy against simple mastectomy with radiotherapy in breast cancer.
        Cancer Treat Rep. 1987; 71: 7-14
        • Jones JM
        • Ribeiro GG
        Mortality patterns over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy.
        Clin Radiology. 1989; 40: 204-208
        • Houghton J
        • Baum M
        • Haybittle JL
        • et al.
        Role of radiotherapy following total mastectomy in patients with early breast cancer.
        World J Surg. 1994; 18: 117-122
        • Rutqvist LE
        • Johansson H
        Mortality by laterality of the primary tumour among 55,000 breast cancer patients from the Swedish cancer registry.
        Br J Cancer. 1990; 61: 866-868
        • Rutqvist LE
        • Lax I
        • Fornander T
        • et al.
        Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer.
        Int J Radiat Oncol Biol Phys. 1992; 22: 887-896
        • Corn BW
        • Trock BJ
        • Goodman RL
        Irradiation-related ischemic heart disease.
        J Clin Oncol. 1990; 8: 741-750
        • Pierce LJ
        Minimizing cardiotoxicity following breast radiotherapy: Treatment planning is the key.
        Cancer J. 2001; 7: 477-479
        • Gyenes G
        Radiation-induced ischemic heart disease in breast cancer.
        Acta Oncol. 1998; 37: 241-246
        • Spence AM
        • Geraci JP
        • Cent RR
        Irradiation and BCNU effects in the stroma in a rat transplanted glioma model: analysis of cerebral tumor bed effect.
        Neuropathol Appl Neurobiol. 1995; 11: 229-244
        • Gustavsson A
        • Eskilsson J
        • Landberg T
        • et al.
        Late cardiac effects after mantle radiotherapy in patients with Hodgkin's disease.
        Ann Oncol. 1990; 1: 355-363
        • Hancock SL
        • Donaldson SS
        • Hoppe RT
        Cardiac disease following treatment of Hodgkin's disease in children and adolescents.
        J Clin Oncol. 1993; 11: 1208-1215
        • Hardenbergh PH
        • Munley MT
        • Bentel GC
        • et al.
        Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: preliminary results.
        Int J Radiat Oncol Biol Phys. 2001; 49: 1023-1028
        • Marks LB
        • Hebert ME
        • Bentel G
        • et al.
        To treat or not to treat the internal mammary nodes: a possible compromise.
        Int J Radiat Oncol Biol Phys. 1994; 29: 903-909
        • Gyenes G
        • Fornander T
        • Carlens P
        • et al.
        Myocardial damage in breast cancer patients treated with adjuvant radiotherapy: a prospective study.
        Int J Radiat Oncol Biol Phys. 1996; 36: 899-905
        • Gyenes G
        • Fornander T
        • Carlens P
        • et al.
        Morbidity of ischemic heart disease in early breast cancer 15-20 years after adjuvant radiotherapy.
        Int J Radiat Oncol Biol Phys. 1994; 28: 1235-1241
        • Gustavsson A
        • Bendahl P
        • Cwikiel M
        • et al.
        No serious late cardiac effects after adjuvant radiotherapy following mastectomy in premenopausal women with early breast cancer.
        Int J Radiat Oncol Biol Phys. 1999; 43: 745-754
        • Hardenbergh PH
        • Recht A
        • Gollamudi S
        • et al.
        Treatment-related toxicity from a randomized trial of the sequencing of doxorubicin and radiation therapy in patients treated for early stage breast cancer.
        Int J Radiat Oncol Biol Phys. 1999; 45: 69-72