Markers of Cardiotoxicity in Early Breast Cancer Patients Treated With a Hypofractionated Schedule: A Prospective Study

Sanctis, Vitaliana De; Alfó, Marco; Vitiello, Cecilia; Vullo, Gianluca; Facondo, Giuseppe; Marinelli, Luca; Burocchi, Simone; Gallo, Giovanna; Valeriani, Maurizio; Campanella, Barbara; Scalabrino, Giovanna; Russo, Ivana; Salerno, Gerardo; Cardelli, Patrizia; Osti, Mattia Falchetto; Biase, Luciano De

doi:10.1016/j.clbc.2020.09.005

Cited by 8 publications

(8 citation statements)

References 33 publications

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“…Donovan et al measured highly sensitive TnI and TnT before and during radiotherapy at week two and four; they found no significant increase in the two markers, but the study population was very small and the cumulative radiation dose was low [63]. De Sanctis et al found no increase in cardiac TnI and BNP levels from baseline related to left breast irradiation [64]. Yu et al investigated whether radiotherapy could induce high sensitivity TnI increases after anthracyclines and trastuzumab based chemotherapy; no significant change in biomarker level was detected from baseline [65].…”

Section: Radiotherapymentioning

confidence: 99%

Role of Cardiac Biomarkers in Cancer Patients

Semeraro

Cipolla

Cardinale

2021

Cancers

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In patients with cancer—and especially some specific subtypes—the heart can be pathologically affected due to the direct action of the tumor or its secretion products or due to the toxicity of some oncological treatments. Cardiac biomarkers have been investigated as inexpensive and easily accessible tools for prediction, early diagnosis, monitoring, or prognosis of various forms of cancer-related cardiac diseases. However, their clinical usefulness was not always clearly demonstrated in every area of cardioncology. For the identification of anthracycline related cardiotoxicity in the very early stages troponins proved to be more efficient detectors than imaging methods. Nevertheless, the lack of a standardized dosage methodology and of cardiotoxicity specific thresholds, do not yet allow to outline the precise way to employ them in clinical routine and to incorporate them into appropriate diagnostic or managing algorithms. Cardiac biomarkers proved also effective in patients with primary cardiac amyloidosis, in which both troponins and natriuretic peptides were able to predict adverse outcome, and carcinoid heart disease, where a precise diagnostic cut-off for N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was identified to screen patients with valvular involvement. Likewise, NT-proBNP proved to be an excellent predictor of postoperative atrial fibrillation (POAF). On the contrary, evidence is still not sufficient to promote the routine use of cardiac biomarkers to early diagnose myocarditis due to immune check points inhibitors (ICIs), radiotherapy induced cardiotoxicity and cardiac complications related to androgenetic deprivation. In this review we present all the evidence gathered so far regarding the usefulness and limitations of these relatively inexpensive diagnostic tools in the field of cardio-oncology.

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Section: Radiotherapymentioning

confidence: 99%

Role of Cardiac Biomarkers in Cancer Patients

Semeraro

Cipolla

Cardinale

2021

Cancers

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“…Exclusion of chemotherapy limits generalisability Skyttä et al, 2019 [ 20 ] Prospective 80 Breast cancer or DCIS (L/R = 60/20) 50 Gy/25Fx ± boost or 42.6 Gy/16Fx 3DCRT Not Permitted 3.1 (1.5) b hsTnT, NT-proBNP Pre-RT, immediately after RT and 3 years after RT No association of biomarkers with cardiac dosimetry Exclusion of chemotherapy limits generalisability Demissei et al, 2019 [ 21 ] Prospective 87 Breast cancer (60; L/R = NR), Lung Cancer (13), Mediastinal lymphoma (14) Conventional fractionation) Photon (technique NR) or Protons Permitted 1.5 (1.1) b hsTnT, NT-proBNP, PIGF, GDF-15 Pre-RT and a median of 20 days post-RT (IQR 1–35) No association of biomarkers with cardiac dosimetry in breast cancer patients PIGF and GDF-15 associated with cardiac dosimetry in lung and lymphoma group, though sample size was small. Analysis for left breast not performed Yu et al, 2019 [ 22 ] Retrospective 47 Her2 + breast cancer (L/R = 26/21) 50 Gy/25Fx or 42.4 Gy/16Fx ± boost 3DCRT or IMRT Permitted 1.8 (1.5) b hsTnI Baseline (Pre-Chemotherapy), Pre-RT, immediately post-RT and 6 months post-RT Statistical analysis not performed due to incomplete data on paired samples - De Sanctis et al, 2020 [ 24 ] Prospective 44 Breast cancer (L/R = 27/17) 42.4 Gy/16Fx ± boost 3DCRT Permitted 1.3 (NR) b …”

Section: Discussionmentioning

confidence: 99%

Cardiac markers in left-sided breast cancer patients receiving adjuvant radiotherapy: a prospective study

Chufal,

Ahmad,

Prakash

et al. 2024

Cardio-Oncology

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Objectives To investigate the association between radiotherapy (RT) and cardiac biomarkers in women with left-sided breast cancer. Methods This prospective observational study recruited patients with stage I-III left-sided breast cancer without coronary heart disease who required adjuvant RT. High-sensitivity troponin I(hsTnI), N-terminal pro-brain natriuretic peptide(NT-proBNP), and high-sensitivity C-reactive protein(hsCRP) levels were measured pre-RT, immediately after RT, and 3 months post-RT. Cardiac-sparing RT techniques were utilized (Field-in-Field IMRT/VMAT ± voluntary deep inspiration breath-hold). Statistical analyses were performed using non-parametric tests and multivariable quantile regression (QR). Results One hundred five patients completed the study, with 63 evaluable at three months post-RT. Pre- and post-RT biomarkers showed no significant differences. Median pre-RT and post-RT values were: hsTnI (0.012ng/mL; 0.012ng/mL), hsCRP (3.1 mg/L; 2.8 mg/L), and NT-proBNP (59pg/mL; 45pg/mL). Three months post-RT, hsTnI, hsCRP and NT-proBNP levels also showed no significant differences. Multivariable QR revealed no association between heart Dmean [median(IQR): 2.87 Gy (2.05–3.94)] and post-RT biomarkers. Age and BMI were associated with hsCRP and NT-proBNP, respectively. Conclusions hsTnI, NT-proBNP, and hsCRP are not correlated with contemporary low cardiac exposure in left-sided breast cancer patients treated with contemporary RT techniques.

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“…Many groups have explored and been unable to define the predictive value of using cardiac biomarkers (eg, cardiac troponin, CRP, NT-proBNP) for early detection of cancer therapy-induced cardiac toxicity. 19,[42][43][44][45] These studies usually involved small numbers of patients with quite heterogenous thoracic disease 19,42,43 as well as lower prescribed radiation doses; for example, in the Kuo study, only 13 of 30 patients had NSCLC, and the radiation dose was only 50.4 Gy. Other studies involved patients with breast cancer, for whom cardiac structures can be avoided in radiation treatment planning.…”

Section: Discussionmentioning

confidence: 99%

“…Reported cardiac exposures associated with treatment of breast cancer are usually quite low, and the total dose is lower than that typically used for definitive concurrent chemoradiation for NSCLC. [43][44][45] Both De Sanctis 43 and Palumbo 45 reported finding no elevation in longitudinal measurements of NT-proBNP levels or any association with cardiac toxicity in prospective studies of patients with early breast cancer; Palumbo reported finding a strong correlation between the normalized NT-proBNP and cardiac dosimetry. In another study, cardiac radiation dosimetric parameters correlated strongly with DGF-15 and placental growth factor levels during treatment for patients with lung cancer.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Prognostic Value of High-Sensitivity Cardiac Troponin T for Early Prediction of Chemoradiation Therapy-Induced Cardiotoxicity in Patients with Non-Small Cell Lung Cancer: A Secondary Analysis of a Prospective Randomized Trial

Xu¹,

Meng²,

Gilchrist³

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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Research data are stored in an institutional repository and will be shared upon request to the corresponding author.Acknowledgments-The high-sensitivity cardiac troponin (hs-cTnT) reagents were provided by Roche Diagnostics, Indianapolis, Indiana, as part of a research agreement. The funding agencies and Roche Diagnostics played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Zhongxing Liao and Ting Xu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The authors are extremely grateful for the expert editorial work performed by Christine Wogan, MS, ELS, of MD Anderson's Division of Radiation Oncology.

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Markers of Cardiotoxicity in Early Breast Cancer Patients Treated With a Hypofractionated Schedule: A Prospective Study

Cited by 8 publications

References 33 publications

Role of Cardiac Biomarkers in Cancer Patients

Role of Cardiac Biomarkers in Cancer Patients

Cardiac markers in left-sided breast cancer patients receiving adjuvant radiotherapy: a prospective study

Assessment of Prognostic Value of High-Sensitivity Cardiac Troponin T for Early Prediction of Chemoradiation Therapy-Induced Cardiotoxicity in Patients with Non-Small Cell Lung Cancer: A Secondary Analysis of a Prospective Randomized Trial

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