الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Although breast cancer is among the most common malignancies worldwide and with appropriate treatment the survival of the patients markedly improved. yet it is not without significant long-term risks. Patients with Her2-positive breast cancer treated with trastuzumab have higher rates of cardiotoxicity (CT). Left breast radiation might increase the risk for CT from cardiac exposure to radiation. The routine combination of RT with systemic therapies including trastuzumab may increase cardiac and pulmonary morbidity.
The data on assessment of the effect of this routine combination toxicity is lacking so we aimed at evaluating the toxic effect the concomitant use of radiotherapy and trastuzumab. Also the cardiac toxicity was assumed to be related not only to the cardiac dose but also to the dose received by its substructures like the ventricles and LAD, so we aimed to study the correlation between the heart and its substructures’ dose and the development of cardiac toxicity.
In our study we included 252 female breast cancer patients who were treated in the department of Radiation Oncology, Massachusetts General Hospital (MGH), Boston, USA between 2000 and 2014. They were compared regarding the effect of the concomitant uses of trastuzumab and Radiotherapy and study the effect of each factor separately on the development of cardiac and lung toxicity. Moreover, we generated a dosimetric study to assess the development of cardiac events and the radiotherapy dose received by the heart, the ventricles and LAD.
Our results showed that in patients treated with trastuzumab, compared to right sided the left-side cases showed statistically significant development of arrhythmia (14.2%) versus (< 1%) (p < 0.001). Cardiac ischemia was found in 10 patients in left and one patient in right side (p = 0.011).