左前降支动脉剂量与乳腺癌放疗后心脏事件相关。

Dose to the Left Anterior Descending Artery Correlates With Cardiac Events After Irradiation for Breast Cancer.

机构信息

Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan.

Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan; Department of Radiation Oncology, Beaumont Hospital Dearborn, Dearborn, Michigan.

出版信息

Int J Radiat Oncol Biol Phys. 2022 Sep 1;114(1):130-139. doi: 10.1016/j.ijrobp.2022.04.019. Epub 2022 Apr 25.

DOI:10.1016/j.ijrobp.2022.04.019

PMID:35483540

Abstract

PURPOSE

Although global heart dose has been associated with late cardiac toxic effects in patients who received radiation therapy for breast cancer, data detailing the clinical significance of cardiac substructure dosimetry are limited. We investigated whether dose to the left anterior descending artery (LAD) correlates with adverse cardiac events.

METHODS AND MATERIALS

We identified 375 consecutively treated female patients from 2012 to 2018 who received left-sided breast or chest wall irradiation (with or without regional nodal irradiation). Medical records were queried to identify cardiac events after radiation therapy. Mean and maximum LAD and heart doses (LAD D, LAD D, heart D, and heart D) were calculated and converted to 2-Gy equivalent doses (EQD). Univariate and multivariable Cox regression analyses were performed to determine association with cardiac toxic effects. Potential dose thresholds for each of the 4 dose parameters were identified by receiver operating characteristic (ROC) curve analysis, after which Kaplan-Meier analysis was performed to compare cardiac event-free survival based on these constraints.

RESULTS

Median follow-up time was 48 months. Thirty-six patients experienced a cardiac event, and 23 patients experienced a major cardiac event. On univariate and multivariable analyses, increased LAD D, LAD D, and heart D were associated with increased risk of any cardiac event and a major cardiac event. ROC curve analysis identified a threshold LAD D EQD of 2.8 Gy (area under the ROC curve, 0.69), above which the risk for any cardiac event was higher (P = .001). Similar results were seen when stratifying by LAD D EQD of 6.7 Gy (P = .005) and heart D EQD of 0.8 Gy (P = .01).

CONCLUSIONS

Dose to the LAD correlated with adverse cardiac events in this cohort. Contouring and minimizing dose to the LAD should be considered for patients receiving radiation therapy for left-sided breast cancer.

摘要

目的

尽管全球心脏剂量与接受乳腺癌放射治疗的患者的晚期心脏毒性效应有关，但详细描述心脏亚结构剂量学的临床意义的数据有限。我们研究了左前降支（LAD）剂量是否与不良心脏事件相关。

方法和材料

我们从 2012 年至 2018 年期间连续治疗的 375 例女性患者中确定了 375 例接受左侧乳房或胸壁照射（伴或不伴区域淋巴结照射）的患者。查询病历以确定放射治疗后的心脏事件。计算平均和最大 LAD 和心脏剂量（LAD D、LAD D、心脏 D 和心脏 D），并转换为 2-Gy 等效剂量（EQD）。进行单变量和多变量 Cox 回归分析，以确定与心脏毒性效应的关联。通过接收者操作特征（ROC）曲线分析确定 4 个剂量参数的潜在剂量阈值，然后进行 Kaplan-Meier 分析，根据这些限制比较心脏无事件生存。

结果

中位随访时间为 48 个月。36 例患者发生心脏事件，23 例患者发生主要心脏事件。在单变量和多变量分析中，增加的 LAD D、LAD D 和心脏 D 与任何心脏事件和主要心脏事件的风险增加相关。ROC 曲线分析确定 LAD D EQD 为 2.8 Gy（ROC 曲线下面积，0.69）的阈值，高于该阈值时心脏事件的风险更高（P=0.001）。当按 LAD D EQD 6.7 Gy（P=0.005）和心脏 D EQD 0.8 Gy（P=0.01）分层时，也观察到类似的结果。