Durhan Gamze, Erdemir Ahmet Gürkan, Yuce Sari Sezin, Gultekin Melis, Karakaya Jale, Akpınar Meltem Gülsün, Özyiğit Gökhan, Yildiz Ferah, Demirkazık Figen
Department of Radiology, Hacettepe University Medical School, Ankara, Turkey.
Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey.
Breast Care (Basel). 2020 Dec;15(6):635-641. doi: 10.1159/000508244. Epub 2020 Jun 22.
Lymphatic irradiation in breast cancer improves locoregional control and has been shown to decrease distant metastasis. However, irradiation also accelerates the formation of atherosclerosis and can cause stenosis, not only in the coronary arteries but also in the internal mammary artery (IMA). The aim of this study was to investigate the effects of radiation on IMAs via computed tomography (CT).
We reviewed the data of 3,612 patients with breast cancer treated with radiotherapy (RT) between January 2010 and December 2016. We included 239 patients with appropriate imaging and nodal irradiation in the study. All patients were treated with lymphatic irradiation of 46-50 Gy, and a boost dose (6-10 Gy) to the involved internal mammary nodes (IMNs) when imaging studies demonstrated pathological enlargement. Bilateral IMA diameter and the presence of calcification were assessed via thin contrast-enhanced CT and those of ipsilateral irradiated IMAs were compared with those of contralateral nonirradiated IMAs.
The mean diameter of irradiated IMAs was significantly shorter than that of nonirradiated IMAs, regardless of laterality. All vascular calcifications were determined on the irradiated side. A boost dose of radiation to the IMNs and radiation technique did not significantly affect the IMA diameter or the presence of calcification.
The diameter of the IMA is decreased due to RT regardless of laterality, radiation technique, and administration of a boost dose. Evaluation of vessels on CT before coronary artery bypass graft or flap reconstruction can help the surgeon select the most appropriate vessel.
乳腺癌的淋巴照射可改善局部区域控制，并已显示能减少远处转移。然而，照射也会加速动脉粥样硬化的形成，不仅会导致冠状动脉狭窄，还会导致内乳动脉（IMA）狭窄。本研究的目的是通过计算机断层扫描（CT）研究辐射对内乳动脉的影响。
我们回顾了2010年1月至2016年12月期间接受放射治疗（RT）的3612例乳腺癌患者的数据。我们纳入了239例有适当影像学检查和淋巴结照射的患者进行研究。所有患者均接受46 - 50 Gy的淋巴照射，当影像学检查显示病理性肿大时，对受累的内乳淋巴结（IMN）给予追加剂量（6 - 10 Gy）。通过薄层增强CT评估双侧IMA直径和钙化情况，并将同侧受照射IMA与对侧未受照射IMA进行比较。
无论哪一侧，受照射IMA的平均直径均显著短于未受照射的IMA。所有血管钙化均在受照射侧发现。对IMN的追加辐射剂量和放射技术对IMA直径或钙化的存在没有显著影响。
无论哪一侧、放射技术以及是否给予追加剂量，放疗都会使IMA直径减小。在进行冠状动脉搭桥术或皮瓣重建之前，通过CT评估血管情况有助于外科医生选择最合适的血管。
