Bergom Carmen, Rubenstein Jason, Wilson J Frank, Welsh Aimee, Ibrahim El-Sayed H, Prior Phillip, Schottstaedt Aronne M, Eastwood Daniel, Zhang Mei-Jie, Currey Adam, Puckett Lindsay, Strande Jennifer L, Bradley Julie A, White Julia
Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States.
Front Oncol. 2020 Oct 16;10:506739. doi: 10.3389/fonc.2020.506739. eCollection 2020.
PURPOSE/OBJECTIVES: Node-positive breast cancer patients often receive chemotherapy and regional nodal irradiation. The cardiotoxic effects of these treatments, however, may offset some of the survival benefit. Cardiac magnetic resonance (CMR) is an emerging modality to assess cardiac injury. This is a pilot trial assessing cardiac damage using CMR in patients who received anthracycline-based chemotherapy and three-dimensional conformal radiotherapy (3DCRT) regional nodal irradiation using heart constraints.
Node-positive breast cancer patients (2000-2008) treated with anthracycline-based chemotherapy and 3DCRT regional nodal irradiation (including the internal mammary chain nodes) with heart ventricular constraints (V25 < 10%) were invited to participate. Cardiac tissues were contoured and analyzed separately for whole heart (pericardium) and for combined ventricles and left atrium (myocardium). CMR obtained ventricular function/dimensions, late gadolinium enhancement (LGE), global longitudinal strain (GLS), and extracellular volume fraction (ECV) as measures of cardiac injury and/or early fibrosis. CMR parameters were correlated with dose-volume constraints using Spearman correlations.
Fifteen left-sided and five right-sided patients underwent CMR. Median diagnosis age was 50 (32-77). No patients had baseline cardiac disease before regional nodal irradiation. Median time after 3DCRT was 8.3 years (5.2-14.4). Median left-sided mean heart dose (MHD) was 4.8 Gy (1.1-11.2) and V25 was 5.7% (0-12%). Median left ventricular ejection fraction (LVEF) was 63%. No abnormal LGE was observed. No correlations were seen between whole heart doses and LVEF, LV mass, GLS, or LV dimensions. Increasing ECV did not correlate with increased heart or ventricular doses. However, correlations between higher LV mass and ventricular mean dose, V10, and V25 were seen.
At a median follow-up of 8.3 years, this cohort of node-positive breast cancer patients who received anthracycline-based chemotherapy and regional nodal irradiation had no clinically abnormal CMR findings. However, correlations between ventricular mean dose, V10, and V25 and LV mass were seen. Larger corroborating studies that include advanced techniques for measuring regional heart mechanics are warranted.
目的/目标：淋巴结阳性乳腺癌患者常接受化疗和区域淋巴结照射。然而，这些治疗的心脏毒性作用可能会抵消部分生存获益。心脏磁共振成像（CMR）是一种用于评估心脏损伤的新兴方法。这是一项试点试验，旨在使用CMR评估接受蒽环类化疗和三维适形放疗（3DCRT）区域淋巴结照射（采用心脏限制）的患者的心脏损伤情况。
邀请2000年至2008年期间接受蒽环类化疗和3DCRT区域淋巴结照射（包括内乳链淋巴结）且心室限制（V25＜10%）的淋巴结阳性乳腺癌患者参与。分别对全心（心包）以及心室和左心房联合区域（心肌）的心脏组织进行轮廓勾画和分析。CMR获取心室功能/尺寸、钆延迟增强（LGE）、整体纵向应变（GLS）和细胞外容积分数（ECV），作为心脏损伤和/或早期纤维化的指标。使用Spearman相关性分析CMR参数与剂量 - 体积限制之间的关系。
15例左侧和5例右侧患者接受了CMR检查。中位诊断年龄为50岁（32 - 77岁）。在区域淋巴结照射前，无患者有基线心脏疾病。3DCRT后的中位时间为8.3年（5.2 - 14.4年）。左侧患者的中位全心平均剂量（MHD）为4.8 Gy（1.1 - 11.2），V25为5.7%（0 - 12%）。左心室射血分数（LVEF）的中位值为63%。未观察到异常的LGE。全心剂量与LVEF、左心室质量、GLS或左心室尺寸之间未发现相关性。ECV升高与心脏或心室剂量增加无关。然而，观察到左心室质量增加与心室平均剂量、V10和V25之间存在相关性。
在中位随访8.3年时，该组接受蒽环类化疗和区域淋巴结照射的淋巴结阳性乳腺癌患者未出现临床异常的CMR表现。然而，观察到心室平均剂量、V10和V25与左心室质量之间存在相关性。有必要开展更大规模的验证性研究，纳入测量区域心脏力学的先进技术。
