Medical Radiology and Radiation Safety. 2015. Vol. 60. No. 1. P. 33-38


O.P. Trofimova, O.I. Cheban, Z.P. Mikhina, S.V. Medvedev, Ju.I. Prjamikova, N.P. Schipilina, E.V. Timoshkina, E.V. Poddubskaya, A.A. Maklakova, N.V. Vekova, O.C. Zaichenko, A.V. Berdnik, Ju.V. Bikova, M.P. Baranova, I.P. Kovalenko, L.E. Rotobelskaya, S.I. Tkachev

Cardiovascular Complications in Patients with Breast Cancer After Breast-Conserving Treatment

N.N.Blokhin Russian Cancer research center, Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


Purpose: To evaluate the radiation dose on the heart in patients with left-sided localization of breast cancer receiving radiation therapy after breast-concerving treatment on the free breath and breath-hold at a deep breath.

Material and methods: The study included 113 patients with verified breast cancer T1-2N0-1M0 st. with left-sided localization of tumors who were treated in the N.N. Blokhin Russian Cancer Research Center in 2012-2013. Patients were treated with radical organ resection followed by radiation therapy. Radiation therapy (RT) on the free breath was carried out in 53 patients and on breath-hold at deep breaths in 60 patients. RT - 5 times per week dose 2 Gy per day to a total dose of 50 Gy. Radiation dose distribution in under risk organs was assessed for clinical radiotherapy planning parameters V25 Gy and Dmean to heart.

Results: The data presented show a significant reduction in the volume of the heart, which received a dose of 25 Gy - median performance V25 in RT sync breathing in comparison with the free breathing below the 82 % and the average dose of heart-median performance below the 65 %. The difference is not reliable because of the small number of observations.

Conclusion: The RT with breath holding on deep inhalation in patients with left-sided breast cancer localization reduces an average dose to the heart and the heart volume at the dose of 25 Gy. This allows to expect a further reduction in the incidence of cardio-vascular complications.

Key words: radiotherapy, breast cancer, cardiovascular complications


  1. Kaprin A.D., Starinskii V.V., Petrova G.V. Zlokachestvennye novoobrazovaniya v Rossii v 2012 g. (zabolevaemost' i smertnost'). Moscow: FGBU «MNIOI im. P.A. Gertsena» Minzdrava Rossii. 2014. P. 10-12.
  2. Gagliardi G., Constine L., Moiseeko V. Radiation dose-volume effects in the heart. Int. J. Radiat. Oncol. Biol. Phys. 2010. Vol. 76. No. 3. P. S77-S85.
  3. Carver J.R., Shapiro Ch.L., Jacobs A. et al. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J. Clin. Oncol. 2007. Vol. 1. No. 25. P. 3991-4008.
  4. Clarke M., Collins R., Darby S. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomized trials. Lancet, 2005. Vol. 366. No. 9503. P. 2087-2106.
  5. Ridker P.M., Buring J.E., Rifai N. et al. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: The Reynolds score. J. Amer. Med. Assoc. 2007. Vol. 297. No. 6. P. 611-619.
  6. Hooning M.J., Botma A., Aleman B.M. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J. Natl. Cancer Inst. 2007. Vol. 99. No. 5. P. 365-375.
  7. Paszat L.F., Mackillop W.J., Groome P.A. Mortality from myocardial infarction following postmastectomy radiotherapy for breast cancer: A population-based study in Ontario, Canada. Int. J. Radiat. Oncol. Biol. Phys. 1999. Vol. 43. No. 2. P. 755-761.
  8. Harris E.E., Correa C., Hwang W.T. Late cardiac mortality and morbidity in early-stage breast cancer patients after breast-conservation treatment. J. Clin. Oncol. 2006. Vol. 24. No. 25. P. 4100-4106.
  9. Lipshultz S.E., Lipsitz S.R., Sallan S.E. et al. Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer. J. Clin. Oncol. 2002. Vol. 20. No. 23. P. 4517-4522.
  10. Swain S.M., Whaley F.S., Ewer M.S. et al. Congestive heart failure in patients treated with doxorubicin: A retrospective analysis of three trials. Cancer. 2003. Vol. 97. No. 11. P. 2869-2879.
  11. Shapiro C.L., Hardenbergh P.H., Gelman R. Cardiac effects of adjuvant doxorubicin and radiation therapy in breast cancer patients. J. Clin. Oncol. 1998. Vol. 16. No. 11. P. 3493-3501.
  12. Adams M.J., Hardenbergh P.H., Constine L.S. et al. Radiation-associated cardiovascular disease. Crit. Rev. Oncol. Hematol. 2003. Vol. 45. No. 1. P. 55-75.
  13. Prosnitz R.G., Chen Y.H., Marks L.B. Cardiac toxicity following thoracic radiation. Semin. Oncol. 2005. Vol. 32. No. 2. P. S71-S80.
  14. Wei X., Liu H.H., Tucker S.L. et al. Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 2008. Vol. 70. No. 3. P. 707-714.
  15. Cuzick J., Stewart H., Rutqvist L. et al. Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J. Clin. Oncol. 1994. Vol. 12. No. 3. P. 447-453.
  16. Marks L.B., Yu X., Prosnitz R.G. et al. The incidence functional consequences of RT-associated cardiac perfusion defects. Int. J. Radiat. Oncol. Biol. Phys. 2005. Vol. 63. No. 1. P. 214-223.
  17. Darby S.C., McGale P., Taylor C.W. et al. Long-term mortality from heart disease study of about 300 000 women in US SEER cancer registries. Lancet Oncol. 2005. Vol. 6. No. 8. P. 557-565.
  18. Patt D.A., Goodwin J.S., Kuo Y.F. et al. Cardiac morbidity of adjuvant radiotherapy for breast cancer. J. Clin. Oncol. 2005. Vol. 23. No. 30. P. 7475-7482.
  19. Borger J.N., Hooning M.J., Boersma L.J. et al. Cardiotoxic effects of tangential breast irradiation in early breast patients: The role of irradiated heart volume. Int. J. Radiat. Oncol. Biol. Phys. 2007. Vol. 69. No. 4. P. 1131-1138.
  20. Utehina O. Healthy tissue sparing postoperative radiotherapy for treatment of early stage breast cancer. Riga. Summary of the doctoral thesis. 2009. 32 p.

For citation: Trofimova OP, Cheban OI, Mikhina ZP, Medvedev SV, Prjamikova JuI, Schipilina NP, Timoshkina EV, Poddubskaya EV, Maklakova AA, Vekova NV, Zaichenko OC, Berdnik AV, Bikova JuV, Baranova MP, Kovalenko IP, Rotobelskaya LE, Tkachev SI. Cardiovascular Complications in Patients with Breast Cancer after Breast-Conserving Treatment. Medical Radiology and Radiation Safety. 2015;60(1):33-8. Russian.

PDF (RUS) Full-text article (in Russian)