Early Effects of Breast Cancer Chemotherapy by Fluorouracil, Epirubicin and Cyclophosphamide with or without Docetaxel Regimen on the Right and Left Ventricle Functions

Yıl 2015, Cilt: 1 Sayı: 1, 6 - 12, 01.03.2015

Cemil Bilir , Hüseyin Engin Turgut Karabag Derya Demirtas Orhan Demirtas

Öz

Amaç: Meme kanseri tedavisi Fluorouracil, Epirubicin and Cyclophosphamide (FEC) VEFEC-Docetaxel ile yapılan anjuvan
protokolü sırasında global kardiyak fonksiyon durumunun incelenmesi.
Gereç ve Yöntem: Onkoloji bölümünde meme kanseri nedeniyle adjuvant tedavi gören 51 hasta çalışmaya alındı.
Bulgular: Tedavi başlangıcı ile karşılaştırıldığında 6 aylık tedavi sonrası LVEF 66%±3 den 64.5%±4.4 e düştü, p=0.001. 6
aylık takipte Sol Ventriküler MPI değerleri bazal değerler olan 0.45±0.1 dan 0.58±0.15 e yükseldi, p=0.0001. Tedavi öncesi
ve sonrası ortalama TAPSE değerleri sırasıyla 2.45±0.42 ve 2.05±0.35 cm, p=0.0001 idi. Altı aylık tedavi sonrasında, bazal
ölçümlerler kıyaslandığında Sağ Ventriküler TDI MPI değerlerinde tedavi sonrası anlamlı artış saptandı (0.23 ve 0.37,
p=0.0001). Yalnızca FEC ve Docetaxel fonrası FEC rejimlerine ait tedavi öncesi ve sonrası LVEF, LV MPI, TAPSE ve RV TDI
MPI ölçümlerinin Delta değerleri karşılaştırıldığında, anlamlı bir değişiklik saptanmadı (sırasıyla p= 0.08, p=0.38, p=0.43
and p=0.2).
Sonuç: TAPSE, LVD TDI MPI ve RD TDI MPI ile değerlendirildiğinde, FEC kemoterapisi subklinik Sağ Ventrikül
disfonksiyonuyla ilişkilidir. 

Anahtar Kelimeler

Kemoterapi, FEC-Docetaxel rejimi, Ekokardiografi, TAPSE, tei index

Early Effects of Breast Cancer Chemotherapy by Fluorouracil, Epirubicin and Cyclophosphamide with or without Docetaxel Regimen on the Right and Left Ventricle Functions

Öz

Objectives: to investigate global cardiac functional status during adjuvant chemotherapy with Fluorouracil, Epirubicin and
Cyclophosphamide (FEC) and FEC-Docetaxel protocol for breast cancer.
Material and Method: 51 women treated with adjuvant chemotherapy for breast cancer at the oncology department.
Results: LVEF decreased from baseline values of 66%±3 to 64.5%±4.4, p=0.001 at six month calculations as compared to
the beginning. There was increase in the Left Ventricular MPI values from the baseline records of 0.45±0.1 to 0.58±0.15,
p=0.0001 at six months follow-up. Mean TAPSE values were 2.45±0.42 and 2.05±0.35 cm respectively, p=0.0001. There
was increase in the right ventricular TDI MPI values after the therapy as compared to the baseline calculations (0.23 and
0.37, p=0.0001) at six months. When we compare the delta values of LEVF, LV MPI, TAPSE and RV TDI MPI in group
of FEC alone and FEC followed by Docetaxel regimen, we did not fi nd any signifi cant changes before and after the
chemotherapy (p= 0.08, p=0.38, p=0.43 and p=0.2, respectively).
Conclusion: Chemotherapy with FEC is associated with subclinical right and left ventricular dysfunction as assessed
by TAPSE, left ventricular Doppler myocardial performance index, and right ventricular tissue Doppler myocardial
performance index. 

Anahtar Kelimeler

Chemotherapy, FEC-Docetaxel regimen, Echocardiography, TAPSE, tei index

Kaynakça

• 1. Di Lisi D, Bonura F, Macaione F, Cuttitta F, Peritore A, Meschisi M et al. Chemotherapy-induced cardiotoxicity: role of the conventional echocardiography and the tissue Doppler. Minerva Cardioangiol 201;59:301-8.
• 2. Lotrionte M, Palazzoni G, Natali R, Comerci G, Abbate A, Loperfido F et al. Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy. Minerva Cardioangiol 2007 ;55:711-20.
• 3. Roché H, Fumoleau P, Spielmann M, Canon JL, Delozier T, Serin D et al. Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial. J Clin Oncol 2006;24:5664-71.
• 4. Smith LA, Cornelius VR, Plummer CJ. Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. BMC Cancer 2010;10:337.
• 5. Tanindi A, Demirci U, Tacoy G. Assessment of right ventricular functions during cancer chemotherapy. Eur J Echocardiogr 2011;12:834-40.
• 6. Pearlman AS, Gardin JM, Martin RP, Parisi AF, Popp RL, Quinones MA. Guidelines for optimal physician training in echocardiography. Recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography. Am J Cardiol 1987;60:158-63.
• 7. Lai WW, Gauvreau K, Rivera ES. Accuracy of guideline recommendations for two-dimensional quantification of the right ventricle by echocardiography. Int J Cardiovasc Imaging 2008;24:691-98.
• 8. Karakurt O, Akdemir R. Right ventricular function in ST elevation myocardial infarction: effect of reperfusion. Clin Invest Med 2009;32:285-92.
• 9. Akdemir R, Karakurt O, Kilic H, Yesilay AB, Dogan M, Cagirci G. Effect of reperfusion therapy on index of myocardial performance in acute myocardial infarction: thrombolytics versus primary angioplasty. Heart Vessels 2010;25:87–91.
• 10. Yuasa T, Otsuji Y, Kuwahara E, Takasaki K, Yoshifuku S, Yuge K. Noninvasive prediction of complications with anteroseptal acute myocardial infarction by left ventricular Tei index. J Am Soc Echocardiogr 2005;18:20-25.
• 11. Dokainish H, Abbey H, Gin K, Ramanathan K, Lee PK, Jue J. Usefulness of tissue Doppler imaging in the diagnosis and prognosis of acute right ventricular infarction with inferior Wall acute left ventricular infarction. Am J Cardiol 2005;95:1039-42.
• 12.Saxena N, Rajagopalan N, Edelman K, López-Candales A. Tricuspid annular systolic velocity: a useful measurement in determining right ventricular systolic function regardless of pulmonary artery pressures. Echocardiography 2006;23:750-55.