Troponin T-release associates with cardiac radiation doses during adjuvant left-sided breast cancer radiotherapy

Radiation Oncology

Pirkko-Liisa Kellokumpu-Lehtinen⁴  Pekka Raatikainen¹  Vesa Virtanen³  Eeva Boman²  Suvi Tuohinen³  Tanja Skyttä⁴ 

[1] Department of Medicine, Central Finland Health Care District and University of Eastern Finland, Jyväskylä, Finland;Department of Oncology, Tampere University Hospital and Department of Medical Physics, Medical Imaging Center and Hospital Pharmacy, Tampere, Finland;Heart Center Co and School of Medicine, University of Tampere, Tampere University Hospital, Tampere, Finland;Department of Oncology and School of Medicine, Tampere University Hospital, University of Tampere, Tampere, 33521, Finland

关键词: High sensitivity cardiac troponin T;    Cardiotoxicity;    Breast cancer;    Radiotherapy;   

Others  :  1228504
DOI  :  10.1186/s13014-015-0436-2

 received in 2015-04-13, accepted in 2015-06-05,  发布年份 2015

【 摘 要 】

Background

Adjuvant radiotherapy (RT) for left-sided breast cancer increases cardiac morbidity and mortality. For the heart, no safe radiation threshold has been established. Troponin T is a sensitive marker of myocardial damage. Our aim was to evaluate the effect of left-sided breast cancer RT on serum high sensitivity troponin T (hscTnT) levels and its association with cardiac radiation doses and echocardiographic parameters.

Methods

A total of 58 patients with an early stage, left-sided breast cancer or ductal carcinoma in situ (DCIS) who received adjuvant breast RT without prior chemotherapy were included in this prospective, non-randomized study. Serum samples were taken before, during and after RT. An increase of hscTnT >30 % was predefined as significant. A comprehensive 2D echocardiograph and electrocardiogram (ECG) were performed before and after RT. Dose-volume histograms (DVHs) were generated for different cardiac structures.

Results

The hscTnT increased during RT from baseline in 12/58 patients (21 %). Patients with increased hscTnT values (group A, N = 12) had significantly higher radiation doses for the whole heart (p = 0.02) and left ventricle (p = 0.03) than patients without hscTnT increase (group B, N = 46). For the left anterior descending artery (LAD), differences between groups A and B were found in volumes receiving 15 Gy (p = 0.03) and 20 Gy (p = 0.03) Furthermore, after RT, the interventricular septum thickened (p = 0.01), and the deceleration time was prolonged (p = 0.008) more in group A than in group B.

Conclusions

The increase in hscTnT level during adjuvant RT was positively associated with the cardiac radiation doses for the whole heart and LV in chemotherapy-naive breast cancer patients. Whether these acute subclinical changes increase the risk of excessive long-term cardiovascular morbidity or mortality, will be addressed in the follow-up of our patients.

【 授权许可】

   
2015 Skyttä et al.

【 图 表 】

Fig. 1.

Fig. 2.

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