Hardenbergh P H, Munley M T, Bentel G C, Kedem R, Borges-Neto S, Hollis D, Prosnitz L R, Marks L B
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
Int J Radiat Oncol Biol Phys. 2001 Mar 15;49(4):1023-8. doi: 10.1016/s0360-3016(00)01531-5.
To determine the incidence and dose dependence of regional cardiac perfusion abnormalities in patients with left-sided breast cancer treated with radiation therapy (RT) with and without doxorubicin (Dox).
Twenty patients with left-sided breast cancer underwent cardiac perfusion imaging using single photon emission computed tomography (SPECT) prechemotherapy, pre-RT, and 6 months post-RT. SPECT perfusion images were registered onto 3-dimensional (3D) RT dose distributions. The volume of heart in the RT field was quantified, and the regional RT dose was calculated. A decrease in regional cardiac perfusion was assessed subjectively by visual inspection and objectively using image fusion software. Ten patients received Dox-based chemotherapy (total dose 120-300 mg/m(2)), and 10 patients had no chemotherapy. RT was delivered by tangent beams in all patients to a total dose of 46-50 Gy.
Overall, 60% of the patients had new visible perfusion defects 6 months post-RT. A dose-dependent perfusion defect was seen at 6 months with minimal defect appreciated at 0-10 Gy, and a 20% decrease in regional perfusion at 41-50 Gy. One of 20 patients had a decrease in left ventricle ejection fraction (LVEF) of greater than 10% at 6 months; 2/20 patients had developed transient pericarditis. No instances of myocardial infarction or congestive heart failure (CHF) have occurred.
RT causes cardiac perfusion defects 6 months post-RT in most patients. Long-term follow-up is needed to assess whether these perfusion changes are transient or permanent and to determine if these findings are associated with changes in overall cardiac function and clinical outcome.
确定接受或未接受阿霉素（Dox）治疗的左侧乳腺癌患者在放疗（RT）后局部心脏灌注异常的发生率及剂量依赖性。
20例左侧乳腺癌患者在化疗前、放疗前及放疗后6个月接受单光子发射计算机断层扫描（SPECT）心脏灌注成像。SPECT灌注图像与三维（3D）放疗剂量分布进行配准。对放疗野内的心脏体积进行量化，并计算局部放疗剂量。通过视觉检查主观评估局部心脏灌注的降低情况，并使用图像融合软件进行客观评估。10例患者接受基于阿霉素的化疗（总剂量120 - 300mg/m²），10例患者未接受化疗。所有患者均采用切线野放疗，总剂量为46 - 50Gy。
总体而言，60%的患者在放疗后6个月出现新的可见灌注缺损。在6个月时观察到剂量依赖性灌注缺损，0 - 10Gy时缺损最小，41 - 50Gy时局部灌注降低20%。20例患者中有1例在6个月时左心室射血分数（LVEF）下降超过10%；2/20例患者发生了短暂性心包炎。未发生心肌梗死或充血性心力衰竭（CHF）病例。
放疗在大多数患者放疗后6个月引起心脏灌注缺损。需要长期随访以评估这些灌注变化是短暂的还是永久性的，并确定这些发现是否与整体心脏功能和临床结局的变化相关。
