Klin Onkol 2007; 20(5): 330-334.
Patients with early stage breast cancer along with pediatric oncology patients belong to most thoroughly monitored groups due to cardiotoxicity of chemotherapy and transcardial radiotherapy . Both short-term and long-term cardiotoxicity of the anticancer treatment is getting all the more attention nowadays when early stage breast carcinoma is considered and treated as a curable disease. Since many of these patients benefit from a long-term survival, the probability of late cardiotoxicity development increases. Our goal is to offer a summary of contemporary knowledge about mechanisms of cardiotoxicity, about its incidence, detection and prevention in the con¬text of breast cancer adjuvant therapy. Current therapeutic alternatives such as the addition of taxanes and trastuzumab to anthracyclines increased the complexity of the situation, as these drugs are cardiotoxic and may potentiate the cardiotoxicity of doxorubicin. Significant increase of heart-failure incidence was described by F. Pein et al., 2004, more than 12 years after anthracycline treatment was administered, notwithstanding the low cumulative doses. Contemporary radiotherapy techniques („respiratory-gating“ and intesity modulated radiotherapy IMRT) reduce the dose administered to myocardium, thereby reducing the risk of cardiotoxicity. In spite of the improved radiotherapy techniques myocardial damage can be caused by the left thorax irradiation after breast-conserving surgery. Optimal way and frequency of cardiac monitoring are still unknown. The use of liposomal doxorubicin and cardioprotection with dexrazoxan in adjuvant setting remain controversial. Therefore, the search for a well-balanced procedure which would minimi¬ze the risk of relapse while consequently lowering the risk of late cardiotoxocity is still on.
