Article Abstract

Analysis of cardiac adverse events following postmastectomy hypofractionated radiotherapy

Authors: Mohsin Khan, Manoj Gupta, Rajeev Seam


Background: Cardiac complications following chest wall irradiation are inevitable. The effects of conventional radiotherapy (RT) delivering 50 Gy in 25 fractions ± boost have been clearly demonstrated in a large number of trials. However, there are limited prospective studies demonstrating the impact of hypofractionated RT on normal cardiac tissues in post-mastectomy patients. Through this trial we tried to quantify the cardiac adverse events after post-mastectomy hypofractionated RT.
Materials and methods: Between June 2011 to June 2012, 61 female patients post-mastectomy were treated with either 40 Gy in 15 fractions or 42.5 Gy in 16 fractions. All patients had echocardiography (ECHO) done before start of RT, and then at three monthly intervals till last follow up. The Common Terminology Criteria (CTC) for Adverse Events v 3.0 was employed to evaluate early and late effects of RT.
Results: Median age of patients was 49 years. Average length and width of tangential portals were 19.5 cm × 1.5 cm, and 6.8 cm × 1.2 cm respectively. A total of 3.3% of the patients developed acute grade (Gr) 2 toxicity, while for late reactions, 8.2% and 6.6% had Gr 2 and Gr 3 adverse events respectively at a median follow up 20 months.
Conclusions: Use of hypofractionated RT for chest wall irradiation post-mastectomy is safe with no clinically significant acute or late cardiac adverse event noted at a follow up of 2 years.