与低心脏剂量的曲妥珠单抗和乳房放疗同时应用时，LVEF 无明显变化。
No Acute Changes in LVEF Observed With Concurrent Trastuzumab and Breast Radiation With Low Heart Doses.
机构信息
Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA.
Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA.
出版信息
Clin Breast Cancer. 2017 Nov;17(7):510-515. doi: 10.1016/j.clbc.2017.03.011. Epub 2017 Mar 23.
INTRODUCTION/BACKGROUND: Treatment for HER2-postitive breast cancer often includes trastuzumab, breast/chest wall (CW) radiation (RT), and anthracyclines, all of which have cardiac toxicity. We aimed to evaluate the relationship between heart dose and acute left ventricular ejection fraction (LVEF) changes in patients who received concurrent trastuzumab and breast/CW RT with and without anthracycline use.
PATIENTS AND METHODS
We retrospectively reviewed all nonmetastatic breast cancer patients from 2008 to 2015 who received concurrent trastuzumab and breast/CW RT. Baseline LVEF was compared with the LVEF closest to treatment completion as well as with the lowest post-treatment LVEF. LVEF changes were correlated with laterality, heart dosimetric parameters, and doxorubicin use.
RESULTS
Eighty-eight patients were included in our analysis. The median follow-up was 45 months. Forty-one patients were right-sided and 47 left-sided. Thirty-one patients received doxorubicin, 16 right-sided and 15 left-sided. Mean heart dose was 1.10 Gy and 3.63 Gy for right- and left-sided patients, respectively (P < .001). In the entire cohort, a significant LVEF decrease of 3.0% was observed pre- and post-treatment. There was a significant effect of doxorubicin (P = .013) and a nonsignificant effect of RT laterality (P = .088) on LVEF change. The test of interaction between doxorubicin and laterality was not significant (P = .90). No significant association was found between LVEF change and heart dosimetric parameters, including percent volume of heart receiving 5 Gy (V5), 10 Gy (V10), 20 Gy (V20), and 45 Gy (V45), and maximum dose. Similar results were found when baseline LVEF was compared with the lowest post-treatment LVEF.
CONCLUSION
With cardiac doses < 4 Gy, declines in LVEF were not related to tumor laterality or heart dosimetric parameters. Statistically significant LVEF decreases were mainly attributed to doxorubicin.
简介/背景：曲妥珠单抗、乳房/胸壁（CW）放疗（RT）和蒽环类药物的联合治疗通常用于治疗 HER2 阳性乳腺癌，这些治疗方法均有心脏毒性。我们旨在评估曲妥珠单抗联合乳房/CW RT 治疗并同时使用或不使用蒽环类药物的患者心脏剂量与急性左心室射血分数（LVEF）变化之间的关系。
患者和方法
我们回顾性分析了 2008 年至 2015 年期间接受曲妥珠单抗联合乳房/CW RT 治疗的非转移性乳腺癌患者。将基线 LVEF 与治疗完成时最接近的 LVEF 以及治疗后最低的 LVEF 进行比较。LVEF 的变化与侧别、心脏剂量学参数和多柔比星的使用相关。
结果
88 例患者纳入本分析。中位随访时间为 45 个月。41 例为右侧，47 例为左侧。31 例患者接受了多柔比星治疗，其中 16 例为右侧，15 例为左侧。右侧和左侧患者的平均心脏剂量分别为 1.10 Gy 和 3.63 Gy（P<0.001）。在整个队列中，治疗前后 LVEF 显著下降 3.0%。多柔比星（P=0.013）和 RT 侧别的影响（P=0.088）对 LVEF 变化有显著影响。多柔比星和侧别的交互作用检验不显著（P=0.90）。LVEF 变化与心脏剂量学参数之间无显著相关性，包括心脏接受 5 Gy（V5）、10 Gy（V10）、20 Gy（V20）和 45 Gy（V45）的百分比体积和最大剂量。当将基线 LVEF 与治疗后最低 LVEF 进行比较时，得到了相似的结果。
结论
心脏剂量<4 Gy 时，LVEF 的下降与肿瘤侧别或心脏剂量学参数无关。LVEF 显著下降主要归因于多柔比星。
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