BASIC DATA OF THE RESEARCH PROJECT
- ARRS code: J3-2527
- TITLE: New approaches for prediction of cardiotoxicity in breast cancer radiotherapy
- PROJECT LEADER: Assist. Prof. Tanja Marinko
- DURATION: 1.9.2020 - 31.8.2023
- APPLICANT RESEARCH ORGANISATION: INSTITUTE OF ONCOLOGY LJUBLJANA
- PARTICIPATING RESEARCH ORGANISATIONS: UNIVERSITY MEDICAL
- CENTRE LJUBLJANA and THE FACULTY OF MEDICINE
- FINANCING: Slovenian Research Agency
Background: The use of radiation therapy (RT) has contributed to significant improvement in disease-specific survival for patients with early stage breast cancer. These success with RT, used either alone or in combination with other modalities, resulted in large cohorts of cancer survivors, who are subject to late complications from treatment. Incidental radiation to the heart as part of the initial treatment of breast cancer can result in a range of cardiotoxic effects including coronary artery disease, cardiomyopathy, pericardial disease, valvular dysfunction, and conduction abnormalities. Cardiotoxicity is related to both the volume of heart irradiated and the radiation dose delivered to that volume. There does not appear to be any minimum radiation dose that is entirely safe, and the effects of radiation on the heart increase with increasing doses of radiation.
Some research has already been focused on the analysis of late radiation effects on the heart, but more information is still needed concerning the early radiation toxicity, whose clinical assessment still remains difficult. Actually, the early identification of radiation damage to the heart tissue might prove to be vital for the improvement of the quality of life of the breast cancer survivors. Therefore, specific cardiac serum or plasma biomarkers and strain rate imaging may play a significant role in the detection of early subclinical cardiac changes. They might help to identify those patients who are at a higher risk and may need close follow-up in order to achieve better outcomes. With multivariable predictive models integrating clinical, imaging and biomarker data it might be possible to personalize radiation treatment and minimize cardiotoxic effect of radiotherapy not only at the radiation technique level, but also at the level of a prescribed treatment dose.
The objective of our study is to find novel predictors of cardiotoxicity in patients with breast cancer. Our hypothesis is that by integrating clinical data, echocardiographic imaging data and genetic and plasma biomarkers we will be able to identify molecular signatures of cardiotoxicity. The ability to identify patients at risk of severe cardiotoxicity in advance could enable patient stratification and allow treatment modifications such as the use of very strict dose constraints for heart or its substructure. This would provide a framework for future research towards precision medicine based radiation treatment in breast cancer patients.
We will perform a prospective clinical study, including patients with breast cancer treated with adjuvant radiation treatment at the Institute of Oncology Ljubljana. We will use different imaging techniques and genomic and plasma biomarkers to identify molecular signatures of cardiotoxicity in our clinically well-defined Slovenian patient cohort.