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Evaluation of long term cardiotoxicity after epirubicin containing adjuvant chemotherapy and locoregional radiotherapy for breast cancer using various detection techniques
  1. M T Meinardi1,
  2. W T A van der Graaf1,
  3. J A Gietema1,
  4. M P van den Berg2,
  5. D T Sleijfer1,
  6. E G E de Vries1,
  7. J Haaksma2,
  8. F Boomsma3,
  9. D J van Veldhuisen2
  1. 1Department of Medical Oncology, University Hospital Groningen, Groningen, Netherlands
  2. 2Department of Cardiology, University Hospital Groningen
  3. 3Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands
  1. Correspondence to:
    Professor D J van Veldhuisen, Department of Cardiology, Thoraxcentre, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands;

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Breast cancer patients who present with only locoregional lymphatic metastases have good life expectancy after treatment with surgery and adjuvant anthracycline-containing chemotherapy. Anthracyclines, however, can induce cardiomyopathy, and this may become clinically manifest as chronic heart failure many years after exposure.1 As the occurrence of this side effect is dependent on the cumulative dose given, breast cancer patients with a favourable prognosis are treated with rather low doses of anthracyclines in order to prevent severe cardiac damage.


We investigated 56 breast cancer patients in a cross sectional design, to determine whether a low cumulative dose of the anthracyline compound epirubicin causes chronic cardiac damage.

The patients were two or more years after treatment with adjuvant chemotherapy, consisting of 5-fluorouracil, epirubicin, and cyclophosphamide (FEC). The chemotherapy had been given after mastectomy or after breast conserving treatment, and was followed by locoregional radiotherapy (40 to 50 Gy). Thirty patients had been treated with five cycles of FEC (total cumulative dose of epirubicin, 450 mg/m2). Twenty six patients had received four cycles of FEC (total cumulative dose of epirubicin, 360 mg/m2), followed by high dose combination chemotherapy consisting of cyclophosphamide, thiotepa, and carboplatin with haematopoietic stem cell rescue. Their median age at the time of cardiac evaluation …

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