Pre-operative cardiac workup after anthracycline-based neoadjuvant chemotherapy. Is it really necessary?

• Published in: Annals of the Royal College of Surgeons of England 2011-03, Vol.93 (2), p.127-129
• Main Authors: Shapiro, Ron, Barsuk, Daphna, Segev, Lior, Shimon-Paluch, Shani, Berkenstadt, Haim, Zippel, Douglas B, Papa, Moshe Z
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angina pectoris; Antibiotics, Antineoplastic - administration & dosage; Antibiotics, Antineoplastic - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biopsy; Blood pressure; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - surgery; Cancer therapies; Cardiac arrhythmia; Cardiac function; Chemotherapy; Chemotherapy, Adjuvant; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Echocardiography; Female; Heart Diseases - chemically induced; Heart Diseases - prevention & control; Heart failure; Heart rate; Humans; Intubation; Mastectomy; Medical prognosis; Middle Aged; Patients; Preoperative Care - methods; Retrospective Studies; Schedules; Surgery; Surgical Oncology; Womens health
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588411X12851639107836

In patients receiving pre-operative anthracyclines for locally advanced breast cancer, early cardiotoxicity is a well-recognised complication that may interfere with surgery. The aim of this study was to assess the safety of breast surgery after neoadjuvant treatment with Doxorubicin. A retrospective study of breast cancer patients treated with Doxorubicin as part of their neoadjuvant protocol. All patients were subsequently operated in our institution. Intra-operative and postoperative haemodynamic, cardiac or respiratory events were collected. A total of 83 patients were included. All patients had a normal left ventricular ejection fraction before starting on chemotherapy. Doxorubicin was given in conjunction with Cyclophosphamide and Paclitaxel. The cumulative dose of Doxorubicin was 240 mg/m(2). All patients completed their chemotherapy less than a year before surgery and were clinically asymptomatic. Of the patients, 2.3% displayed a significant reduction in cardiac function to meet cardiotoxicity criteria, although not clinically apparent. No complications occurred intra-operatively or postoperatively. Breast surgery can be safely performed after breast neoadjuvant chemotherapy with Doxorubicin. The risk of early cardiotoxicity does not mandate a cardiac function assessment after completion of treatment. Work-up should be individualised according to the anthracycline regimen, patient's cardiac risk factors and functional status before surgery.