For Those On Herceptin watching your LVEF

[Hopeful]

I am curious as to how many who have experienced a big decrease had radiation to the left breast vs. the right. I have had a 10 point drop over three months with radiation to the left side and 3 weekly Herceptin. Although I chose my radiation center specifically because they were the only facility in my area that could 100% promise me they could keep my heart out of the field, I still think this makes a difference. When I see the topic discussed here, most don't state which side recieved the radiation, so I thought I would ask.

Thanks,

Hopeful

[MJo]

I had radiation to the right breast. Four mugas charted a 16 point drop: from 70 before A/C began in December 2005 to 54 in November 2006 after 36 weeks of Herceptin.

[tousled1]

I had radiation to the right chest/axillary. My first echocardiogram my LVEF was 65 and my last one the LVEF was 55%. I'm due to have my next echo in January. I have been on Herceptin since June.

[StephN]

My radiation was to the right side.

I am not in the "Herceptin vacation" group, but it is interesting that when my mets returned and I had a MUGA, I was only at 55% six months after finishing my Adria and Taxotere (no Herceptin in those days). Five years on Herceptin now and I am up into the 60% range.

I feel that there are other forces at work - like long-term chemo effects. Give yourself some time, ladies. The researchers are not tracking the the LV function on us long termers. Something should be done about that, if so many of us are going to depend on this drug for years to come.

[Donna]

Hi,

I also had a big drop - 11 percent in 3 months. I am now down to 55%. But equally alarming was the right ventricle numbers - they have just come up from 33% to 52% and everything I've read says they should be equal. anyone else have low right numbers, or does that matter at all?

Best to you all,

Donna

[Sheila]

I did not have radiation, but after 3 1/2 years of Herceptin, my latest echo was 60%....I was pleased, although because I have a silicone implant on the left side from reconstruction, they had to use contrast IV to visualise the heart to get the correct numbers. So, if you are getting an echo, and had reconstruction on the left side with an implant, get the contrast, otherwise your score may not be accurate.

[Adriana Mangus]

What does LVEF means? I have radiation rt side...should I be concerned about anything?

[Bev]

To evaluate Left Ventricle Ejection Fraction or Function. I just love telling this to the receptionist when she asks why I'm having Echo/Muga done.

I did left side rads. Looking at my test results, AC decreased LVEF more than anything else. Down to 56. During rads and H went back to 70. Still would have wished this to my right side, but Oh Well.

BB

[Susan]

I had radiation on left side. My first Muga before chemo was 72, after AC chemo, went down to 68, I started my radiation and herceptin at the same time, but after 6 months, I was down to 41. I had to discontinue herceptin at 8 months. I stopped in August, and had another muga this past wed. I'll get the result on this wed. I was put on lisinopril and coreg for my heart, and I must say, I not nearly out of breath as I was, so I'm hoping for a good score!

[panicked911]

I had rads to the right side and 1 year if herceotain and no chemo no chnage at all - had three echos during the process .Susanne

[Lani]

which showed equal incidence of cardiotoxicity whether right or left breast irradiation was utilized. The cardiac injury from breast radiation tends to happen many years later and seems to be associated with poor blood supply to the heart muscle which causes signs and symptoms but does not seem to affect overall survival--but as you know, "knowledge" changes with time! The cardiotoxicity effect of herceptin happens much earlier and seems to be associated with damage to the mitochodria (subcellular organelles) of the heart muscles resulting in enlargement of the heart which makes it a much less efficient pump. Thus, different aspectsof the heart's functioning seems to be effected by radiation and by herceptin and in different time frames.
THAT SAID,
It seems reasonable that it should always be best to go to the most advanced available radiation therapists/radiation therapy facility with respect to equipment/technique/knowledge. Accelerated courses of radiation therapy may make this easier, as travelling far for treatment for six-seven weeks may not seem practical, but travelling for 5 days in a row may be.

Trials of APBI (accelerated partial breast irradiation) are seeming to show at LEAST as good results and SO FAR no additional toxicity. Time will tell...

The latest advances in radiation therapy often have to do with software and technique rather than machinery eg. IMRT(intensity modulated radiation therapy), but one interesting technique is intraoperative radiation therapy, where they place shields to protect tissues.

Unfortunately there is no drug company money or other "big pockets" to adequately fund trials of different types (especially shorter courses) of radiation therapy. Institutions may actually get paid less per patient because the patients have fewer treatments--there is no good mechanism in place to charge patients more for the better and more exact treatments.

Hope this helps!