Chiocchi Marcello, Cerocchi Martina, Di Tosto Federica, Rosenfeld Roberto, Pasqualetto Monia, Vanni Gianluca, De Stasio Vincenzo, Pugliese Luca, Di Donna Carlo, Idone Gaetano, Muscoli Saverio, Portarena Ilaria, Roselli Mario, Garaci Francesco, Floris Roberto
Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome "Tor Vergata", 00133 Rome, Italy.
Department of Diagnostic Imaging and Interventional Radiology, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, 00186 Rome, Italy.
J Pers Med. 2023 Jan 22;13(2):199. doi: 10.3390/jpm13020199.
Breast cancer patients undergoing neoadjuvant chemotherapy with anthracyclines or trastuzumab can suffer cardiotoxic issues. Nowadays, the markers of cardiac damage are still not reliable, and extracellular volume (ECV) calculated from CT could be a promising cardiotoxic marker. Eighty-two patients, treated with two different chemotherapy regimens based on doxorubicin (DOX) or epirubicin-trastuzumab (EPI-TRAS), were retrospectively selected and the variations in extracellular volume (ECV) values were measured and analyzed. Whole Body CT (WB-CT) scans were acquired after 1 min, in the portal phase (PP), and after 5 min, in the delayed phases (DP), at the baseline (T), after one year (T) and after five years (T) from the end of chemotherapies. The values measured by two radiologists with different levels of experience were evaluated in order to assess the inter-reader reproducibility assessment (ICC = 0.52 for PP and DP). Further, we performed a population-based analysis and a drug-oriented subgroup analysis in 54 DOX-treated and 28 EPI-TRAS-treated patients. In the general cohort of women treated with any of the two drugs, we observed in the lapse T-T a relative increase (RI) of 25% vs. 20% (PP vs. DP, < 0.001) as well as in the lapse T-T an RI of 17% vs. 15% (PP vs. DP, < 0.01). The DOX-treated patients reported in the lapse T-T an RI of 22% ( < 0.0001) in PP and an RI of 16% ( = 0.018) in the DP, with ECV values remaining stably high at T both in PP (RI 14.0%, < 0.0001) and in DP (RI 17%, = 0.005) highlighting a possible hallmark of a persisting CTX sub-damage. On the other hand, ECV measured in EPI-TRAS-treated women showed an RI in T-T of 18% ( = 0.001) and 29% ( = 0.006) in PP and DP, respectively, but the values returned to basal levels in T both in the PP ( = 0.12) and in DP setting ( = 0.13), suggesting damage in the first-year post-treatment and a possible recovery over time. For the 82 patients, an echocardiography was performed at T, T= 12 m + 3 m and T = 60 m + 6 m with LVEF values at T (64% ± 5%), T (54% ± 6%) and T (53% ± 8%). WB-CT-derived ECV values could provide a valid imaging marker for the early diagnosis of cardiotoxic damage in BC patients undergoing oncological treatments. We detected different patterns during the follow-up, with stably high values for DOX, whereas EPI-TRAS showed a peak within the first year, suggesting different mechanisms of cardiac damage.
接受蒽环类药物或曲妥珠单抗新辅助化疗的乳腺癌患者可能会出现心脏毒性问题。目前，心脏损伤的标志物仍然不可靠，而通过CT计算得出的细胞外容积（ECV）可能是一种有前景的心脏毒性标志物。我们回顾性选取了82例接受基于阿霉素（DOX）或表柔比星 - 曲妥珠单抗（EPI - TRAS）的两种不同化疗方案治疗的患者，并对细胞外容积（ECV）值的变化进行了测量和分析。在化疗结束后的基线期（T0）、1年后（T1）和5年后（T5），分别于1分钟时在门静脉期（PP）、5分钟时在延迟期（DP）进行全身CT（WB - CT）扫描。由两名经验水平不同的放射科医生测量的值进行了评估，以评估阅片者间的可重复性评估（PP期和DP期的组内相关系数ICC = 0.52）。此外，我们对54例接受DOX治疗和28例接受EPI - TRAS治疗的患者进行了基于人群的分析和以药物为导向的亚组分析。在接受这两种药物中任何一种治疗的女性总体队列中，我们观察到在T0 - T1期间，PP期相对增加（RI）为25%，DP期为20%（P < 0.001）；在T1 - T5期间，PP期RI为17%，DP期为15%（P < 0.01）。接受DOX治疗的患者在T0 - T1期间，PP期RI为22%（P < 0.0001），DP期为16%（P = 0.018），T5时PP期（RI 14.0%，P < 0.0001）和DP期（RI 17%，P = 0.005）的ECV值持续保持高位，突出了可能存在持续CTX亚损伤的特征。另一方面，在接受EPI - TRAS治疗的女性中测量的ECV在T0 - T1期间，PP期RI为18%（P = 0.001），DP期为29%（P = 0.006），但在T5时PP期（P = 0.12）和DP期（P = 0.13）的值均恢复到基础水平，表明治疗后第一年有损伤且可能随时间恢复。对于这82例患者，在T0、T1 = 12个月±3个月和T5 = 60个月±6个月时进行了超声心动图检查，T0时左心室射血分数（LVEF）值为（64% ± 5%），T1时为（54% ± 6%），T5时为（53% ± 8%）。WB - CT得出的ECV值可为接受肿瘤治疗的乳腺癌患者心脏毒性损伤的早期诊断提供有效的影像学标志物。我们在随访期间检测到不同模式，DOX组值持续高位，而EPI - TRAS组在第一年出现峰值，提示心脏损伤机制不同。
