Myocardial perfusion imaging with 99 mTc-tetrofosmin SPECT in breast cancer patients that received postoperative radiotherapy: a case-control study

Purpose: To evaluate the cardiac toxicity of radiotherapy (RT) in breast cancer (BC) patients employing myocardial perfusion imaging (MPI) with Tc-99 m Tetrofosmin - single photon emission computer tomography (T-SPECT). Materials and methods: We studied 46 BC female patients (28 patients with left and 18 patients with right BC) treated with postoperative RT compared to a control group of 85 age-matched females. The median time of RT to SPECT was 40 months (6-263). Results: Abnormalities in the summed stress score (SSS) were found in 54% of left BC patients, 44.4% of right BC patients, and 32.9% of controls. In left BC patients there were significantly more SSS abnormalities compared to controls (4.0 +/- 3.5 vs 2.6 +/- 2.0, p = 0.05) and possible trend of increased abnormalities of right BC patients (3.7 +/- 3.0 vs 2.6 +/- 2.0, p = 0.14). Multiple regression analysis showed more abnormalities in the MPI of left BC patients compared to controls (SSS, p = 0.0001); Marginal toxicity was also noted in right BC patients (SSS, p = 0.045). No additional toxicity was found in patients that received adjuvant cardiotoxic chemotherapy. All T-SPECT abnormalities were clinically silent. Conclusion: The study suggests that radiation therapy to BC patients result in MPI abnormalities but without apparent clinical consequences.