Prospective exploratory analysis of cardiac biomarkers and electrocardiogram abnormalities in patients receiving thoracic radiation therapy with high-dose heart exposure.
Prospective exploratory analysis of cardiac biomarkers and electrocardiogram abnormalities in patients receiving thoracic radiation therapy with high-dose heart exposure.
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DOI：
10.1097/jto.0000000000000306
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发表时间：
2014-10
期刊：
影响因子：
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通讯作者：
Grosshans DR
中科院分区：
文献类型：
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作者：
Gomez DR;Yusuf SW;Munsell MF;Welsh JW;Liao Z;Lin SH;Pan HY;Chang JY;Komaki R;Cox JD;McAleer MF;Grosshans DR
胸部肿瘤患者心脏偶发照射的急性效应还没有很好的描述。我们评估了接受适形放射治疗（RT）的胸部恶性肿瘤患者心脏生物标志物的纵向变化。一项前瞻性试验（2009年2月至2012年12月）入组了25例患者，胸部接受≥45戈伊，治疗前估计心脏接受≥20戈伊。化疗是允许的，除了阿霉素或氟尿嘧啶。在RT前、第一次治疗后24小时内、RT结束时和首次随访（1-2个月）时获得心电图（ECG）、肌钙蛋白I（TnI）和脑钠肽（BNP）测量值。在特定时间对这些生物标志物进行定量，并采用配对t检验评价相对于基线的变化。中位心脏剂量为25.9戈伊（范围10.1-35.1戈伊）。在第一次RT部分后，ECG或中位数TnI或BNP水平未发生变化;在RT结束时，2例患者的TnI和BNP升高，但差异均无统计学意义。在第一次随访时，TnI已恢复正常，但中位BNP仍升高（P=0.042）。在18例仅接受RT的患者中，BNP并没有随着时间的推移而增加。12例患者在RT期间发生了急性ECG变化，其中7例患者在下一次测量时消退。无患者发生具有临床意义的RT相关事件。在高剂量辐射心脏期间观察到BNP增加和ECG变化。这项试点研究的结果值得进一步调查和验证。
Acute effects of incidental cardiac irradiation in patients treated for thoracic cancer are not well characterized. We evaluated longitudinal changes in cardiac biomarkers for patients undergoing conformal radiation therapy (RT) with thoracic malignancies with high-dose cardiac exposure. Twenty-five patients enrolled in a prospective trial (February 2009–December 2012) received ≥45 Gy to the thorax, with pretreatment estimates of ≥20 Gy to the heart. Chemotherapy was allowed except for doxorubicin or fluorouracil. Electrocardiographic (ECG), troponin-I (TnI), and brain natriuretic peptide (BNP) measurements were obtained before RT, within 24 hours of the first fraction, at the end of RT, and at first follow-up (1–2 months). These biomarkers were quantified at specific times and changes from baseline were evaluated with paired t tests. The median heart dose was 25.9 Gy (range 10.1–35.1 Gy). After the first RT fraction, no changes were noted in ECG or median Tnl or BNP levels; at the end of RT, two patients had elevated TnI and BNP, but neither difference was statistically significant. At first follow-up, TnI had returned to normal but the median BNP remained elevated (P=0.042). BNP did not increase over time in the 18 patients who received only RT. Twelve patients experienced acute ECG changes during RT, which resolved in seven patients by the next measurement. No patients experienced clinically significant RT-related events. Increases in BNP and ECG changes were observed during high doses of radiation to the heart. The findings of this pilot study warrant further investigation and validation.