A Comparative Study of Cardiac Toxicity Analysis in Hypo-Fractionated Vs Conventionalfractionated Adjuvant Radiotherapy in Post-Mastectomy Leftbreast Carcinoma

Authors

  • Sonya Begum Registrar, Department of Clinical Oncology, Delta Hospital Ltd, Dhaka, Bangladesh
  • M Kamruzzaman Rumman Assistant Professor, Department of Radiation Oncology, National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh
  • Md Nazmul Haq Assistant Registrar, Department of Cardiac Electrophysiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh
  • Tania Afrin Registrar, Children and Women Cardiac Unit (National Heart Foundation Hospital and Research Institute), Dhaka, Bangladesh
  • Al Mamun Assistant Professor, Department of Cardiac Electrophysiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh
  • Tasneem Hossain Medical Officer, Department of Radiation Oncology, National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh
  • Kamrun Nahar Tania Senior Medical Physicist, National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh
  • Md Shariful Huque Senior Medical Physicist, Department of Radiation Oncology, Labaid Cancer Hospital and Super Speciality Center, Bangladesh
  • Johirul Islam Associate Professor and Head, Department of Cancer Epidemiology, National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh
  • Bipasha Akhter Research Assistant, NSU Genome Research Institute (NGRI) North South University, Dhaka, Bangladesh
  • Md Moarraf Hossen Ex Director and Professor of Radiotherapy, Department of Radiation Oncology, National Institute of Cancer Research & Hospital (NICRH), Dhaka, Bangladesh

DOI:

https://doi.org/10.3329/jbcps.v42i2.72361

Keywords:

Hypo-fractionated Radiotherapy, Conventional Fractionated Radiotherapy, Cardiac Toxicity, Breast Carcinoma, Post Mastectomy

Abstract

Background: Post-mastectomy adjuvant radiotherapy improves long-term survival by reducing the risk of loco-regional recurrence in breast cancer patients with high-risk features. Considering radiation therapy to the left sided chest wall heart is an important organ at risk. Hypo-fractionated radiotherapy is increasingly being used due to involvement of fewer treatment sessions and is almost radio-biologically equivalent to conventionally fractionated radiotherapy.

Objective: This study was conducted to evaluate cardiac toxicities between hypo and conventionally fractionated radiotherapy.

Methods: This quasi-experimental study was done at the National Institute of Cancer Research and Hospital, Mohakhali, Dhaka from January 2019 to December 2019, 60 patients were purposively assigned into two groups and each group included 30 patients. Arm A: received Conventional fractionated radiotherapy (50Gy/25 fractions over 5 weeks, at 2Gy/fraction). Arm B: received Hypo- fractionated radiotherapy (40.05 Gy in 15 fractions over 3 weeks at 2.67 Gy/fraction). Echocardiography (ECHO), Electrocardiography (ECG) was performed to find the cardiac toxicities.

Results: The mean age of the patients in arm A was 50.03 ± 6.82 years and that of arm B was 48.08 ± 5.08 years. No significant statistical difference was found between the two groups regarding socio-demographic variables and clinical presentations. Most of the patients in both arms showed grade 0 cardiac toxicity (arm A: 70% and arm B:  80%) & few showed grade 1 cardiac toxicity (arm A: 20% and arm B: 13.3%) and three patients (10.0%) in arm A and two patients (6.66%) in arm B had shown grade 2 cardiac toxicities six months after treatment.  However, this difference was statistically not significant (p >0.05). Before treatment, the ejection fraction (EF) of arm A and arm B were 63.3 ± 5.621 and 64.7± 4.991. Six months after treatment the EF of both arms decreased (arm A 60.2 ± 4.051 & arm B 60.9 ± 5.121) but the difference was statistically not significant (p >0.05).

Conclusion: Hypo-fractionated radiotherapy in the adjuvant setting for the treatment of left breast cancer has no additional cardiac toxicity in comparison to conventionally fractionated radiotherapy while maintaining same efficacy.

J Bangladesh Coll Phys Surg 2024; 42: 169-175

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Published

2024-04-30

How to Cite

Begum, S. ., Rumman, M. K. ., Haq, M. N. ., Afrin, T. ., Mamun, A. ., Hossain, T., Tania, K. N., Huque, M. S. ., Islam, J., Akhter, B. ., & Hossen, M. M. . (2024). A Comparative Study of Cardiac Toxicity Analysis in Hypo-Fractionated Vs Conventionalfractionated Adjuvant Radiotherapy in Post-Mastectomy Leftbreast Carcinoma. Journal of Bangladesh College of Physicians and Surgeons, 42(2), 169–175. https://doi.org/10.3329/jbcps.v42i2.72361

Issue

Vol. 42 No. 2 (2024)

Section

Original Articles

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