Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: Preliminary results
Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: Preliminary results
复制标题
DOI：
10.1016/s0360-3016(00)01531-5
复制
发表时间：
2001-03-15
影响因子：
7
通讯作者：
Marks, LB
中科院分区：
文献类型：
--
作者：
Hardenbergh, PH;Munley, MT;Marks, LB
目的：探讨阿昔洛比林(Dox)与阿昔洛林(Dox)联合治疗的左侧乳腺癌患者局部心脏灌注异常的发生率和剂量依赖性。方法：对20例左侧乳腺癌患者化疗前、放疗前和放疗后6个月分别进行SPECT心脏灌注成像。SPECT灌注图像被配准到三维(3D)RT剂量分布上。对RT野中的心脏体积进行量化，计算局部RT剂量。通过肉眼检查和使用图像融合软件客观地评估局部心脏灌注的减少。10例患者接受以Dox为基础的化疗(总剂量120~300 mg/m~2)，10例患者未接受化疗。结果：60%的患者在放疗后6个月出现新的可见的灌注缺陷，6个月后出现剂量依赖性的灌注缺陷，在0~10Gy时可见微小的灌注缺陷，在41~50GS时可见局部灌注减少20%。20例患者中1例在6个月时左室射血分数(LVEF)下降超过10%，2/20例患者发生一过性心包炎，未发生心肌梗死或充血性心力衰竭(CHF)。结论：大多数患者放疗后6个月出现心脏血流灌注缺陷，需要长期随访以评估这些血流灌注变化是一过性的还是永久性的，并确定这些发现是否与整体心功能和临床预后的变化有关。(C)2001年爱思唯尔科学公司。
Purpose: To determine the incidence and dose dependence of regional cardiac perfusion abnormalities in patients with left-sided breast cancer treated with radiation therapy (RT) with and without doxorubirin (Dox),Methods: Twenty patients with left-sided breast cancer underwent cardiac perfusion imaging using single photon emission computed tomography (SPECT) prechemotherapy, pre-RT, and 6 months post-RT. SPECT perfusion images were registered onto 3-dimensional (3D) RT dose distributions. The volume of heart in the RT field was quantified, and the regional RT dose was calculated. A decrease in regional cardiac perfusion was assessed subjectively by visual inspection and objectively using image fusion software. Ten patients received Dox-based chemotherapy (total dose 120-300 mg/m(2)), and 10 patients had no chemotherapy. RT was delivered by tangent beams in all patients to a total dose of 46-50 Gy,Results: Overall, 60% of the patients had new visible perfusion defects 6 months post-RT, A dose-dependent perfusion defect was seen at 6 months with minimal defect appreciated at 0-10 Gy, acid a 20% decrease in regional perfusion at 41-50 GS. One of 20 patients had a decrease in left ventricle ejection fraction (LVEF) of greater than 10% at 6 months; 2/20 patients had developed transient pericarditis, No instances of myocardial infarction or congestive heart failure (CHF) have occurred.Conclusions: RT causes cardiac perfusion defects 6 months post-RT in most patients, Long-term follow-up is needed to assess whether these perfusion changes are transient or permanent and to determine if these findings are associated with changes in overall cardiac function and clinical outcome. (C) 2001 Elsevier Science Inc.