Honaryar Manoj Kumar, Allodji Rodrigue, Ferrières Jean, Panh Loïc, Locquet Médéa, Jimenez Gaelle, Lapeyre Matthieu, Camilleri Jérémy, Broggio David, de Vathaire Florent, Jacob Sophie
INSERM U 1018, CESP, Radiation Epidemiology Team, 94800 Villejuif, France.
Institute Gustave Roussy, 94800 Villejuif, France.
Cancers (Basel). 2022 Nov 22;14(23):5724. doi: 10.3390/cancers14235724.
Background: Radiotherapy (RT) for breast cancer (BC) can induce coronary artery disease many years after RT. At an earlier stage, during the first two years after RT, we aimed to evaluate the occurrence of increased coronary artery calcium (CAC) and its association with cardiac exposure. Methods: This prospective study included 101 BC patients treated with RT without chemotherapy. Based on CAC CT scans performed before and two years after RT, the event ‘CAC progression’ was defined by an increase in overall CAC score (CAC RT+ two years—CAC before RT > 0). Dosimetry was evaluated for whole heart, left ventricle (LV), and coronary arteries. Multivariable logistic regression models were used to assess association with doses. Results: Two years after RT, 28 patients presented the event ‘CAC progression’, explained in 93% of cases by a higher CAC score in the left anterior descending coronary (LAD). A dose−response relationship was observed with LV exposure (for Dmean LV: OR = 1.15, p = 0.04). LAD exposure marginally explained increased CAC in the LAD (for D2 LV: OR =1.03, p = 0.07). Conclusion: The risk of early CAC progression may be associated with LV exposure. This progression might primarily be a consequence of CAC increase in the LAD and its exposure.
乳腺癌放疗（RT）多年后可诱发冠状动脉疾病。在放疗后的早期，即放疗后的头两年，我们旨在评估冠状动脉钙化（CAC）增加的发生率及其与心脏受照剂量的关联。方法：这项前瞻性研究纳入了101例接受放疗但未接受化疗的乳腺癌患者。根据放疗前及放疗后两年进行的CAC CT扫描，“CAC进展”事件定义为总体CAC评分增加（放疗后两年的CAC评分 - 放疗前的CAC评分>0）。对全心、左心室（LV）和冠状动脉进行剂量测定。使用多变量逻辑回归模型评估与剂量的关联。结果：放疗后两年，28例患者出现“CAC进展”事件，93%的病例可通过左前降支冠状动脉（LAD）较高的CAC评分来解释。观察到与左心室受照剂量存在剂量 - 反应关系（对于左心室平均剂量：OR = 1.15，p = 0.04）。左前降支受照剂量对左前降支CAC增加的解释作用微弱（对于左心室D2剂量：OR = 1.03，p = 0.07）。结论：早期CAC进展的风险可能与左心室受照剂量有关。这种进展可能主要是左前降支CAC增加及其受照剂量的结果。
