A Pilot Study of Cardiac MRI in Breast Cancer Survivors After Cardiotoxic Chemotherapy and Three-Dimensional Conformal Radiotherapy

Frontiers in Oncology

Aronne M. Schottstaedt¹  Aimee Welsh²  Jason Rubenstein²  Jennifer L. Strande²  Julia White³  J. Frank Wilson⁴  Adam Currey⁴  Phillip Prior⁴  Lindsay Puckett⁴  Carmen Bergom⁴  Julie A. Bradley⁵  El-Sayed H. Ibrahim⁷  Daniel Eastwood⁸  Mei-Jie Zhang⁸ 

[1] Department of Medicine, Case Western Reserve University, Cleveland, OH, United States;Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, United States;Department of Radiation Oncology, James Cancer Hospital, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States;Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States;Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States;Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States;Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States;Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States;

关键词: 3D conformal radiation therapy;    cardiotoxicity;    cardiac MRI;    radiation therapy;    breast cancer;   

DOI  :  10.3389/fonc.2020.506739

来源: DOAJ

【 摘 要 】

Purpose/ObjectivesNode-positive breast cancer patients often receive chemotherapy and regional nodal irradiation. The cardiotoxic effects of these treatments, however, may offset some of the survival benefit. Cardiac magnetic resonance (CMR) is an emerging modality to assess cardiac injury. This is a pilot trial assessing cardiac damage using CMR in patients who received anthracycline-based chemotherapy and three-dimensional conformal radiotherapy (3DCRT) regional nodal irradiation using heart constraints.Materials and MethodsNode-positive breast cancer patients (2000–2008) treated with anthracycline-based chemotherapy and 3DCRT regional nodal irradiation (including the internal mammary chain nodes) with heart ventricular constraints (V25 < 10%) were invited to participate. Cardiac tissues were contoured and analyzed separately for whole heart (pericardium) and for combined ventricles and left atrium (myocardium). CMR obtained ventricular function/dimensions, late gadolinium enhancement (LGE), global longitudinal strain (GLS), and extracellular volume fraction (ECV) as measures of cardiac injury and/or early fibrosis. CMR parameters were correlated with dose-volume constraints using Spearman correlations.ResultsFifteen left-sided and five right-sided patients underwent CMR. Median diagnosis age was 50 (32–77). No patients had baseline cardiac disease before regional nodal irradiation. Median time after 3DCRT was 8.3 years (5.2–14.4). Median left-sided mean heart dose (MHD) was 4.8 Gy (1.1–11.2) and V25 was 5.7% (0–12%). Median left ventricular ejection fraction (LVEF) was 63%. No abnormal LGE was observed. No correlations were seen between whole heart doses and LVEF, LV mass, GLS, or LV dimensions. Increasing ECV did not correlate with increased heart or ventricular doses. However, correlations between higher LV mass and ventricular mean dose, V10, and V25 were seen.ConclusionAt a median follow-up of 8.3 years, this cohort of node-positive breast cancer patients who received anthracycline-based chemotherapy and regional nodal irradiation had no clinically abnormal CMR findings. However, correlations between ventricular mean dose, V10, and V25 and LV mass were seen. Larger corroborating studies that include advanced techniques for measuring regional heart mechanics are warranted.

【 授权许可】

Unknown