Document Detail


The incidence and functional consequences of RT-associated cardiac perfusion defects.
MedLine Citation:
PMID:  16111592     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Radiation therapy (RT) for left-sided breast cancer has been associated with cardiac dysfunction. We herein assess the temporal nature and volume dependence of RT-induced left ventricular perfusion defects and whether these perfusion defects are related to changes in cardiac wall motion or alterations in ejection fraction. METHODS: From 1998 to 2001, 114 patients were enrolled onto an IRB-approved prospective clinical study to assess changes in regional and global cardiac function after RT for left-sided breast cancer. Patients were imaged 30 to 60 minutes after injection of technetium 99m sestamibi or tetrofosmin. Post-RT perfusion scans were compared with the pre-RT studies to assess for RT-induced perfusion defects as well as functional changes in wall motion and ejection fraction. Two-tailed Fisher's exact test and the Cochran-Armitage test for linear trends were used for statistical analysis. RESULTS: The incidence of new perfusion defects 6, 12, 18, and 24 months after RT was 27%, 29%, 38%, and 42%, respectively. New defects occurred in approximately 10% to 20% and 50% to 60% of patients with less than 5%, and greater than 5%, of their left ventricle included within the RT fields, respectively (p = 0.33 to 0.00008). The rates of wall motion abnormalities in patients with and without perfusion defects were 12% to 40% versus 0% to 9%, respectively; p values were 0.007 to 0.16, depending on the post-RT interval. CONCLUSIONS: Radiation therapy causes volume-dependent perfusion defects in approximately 40% of patients within 2 years of RT. These perfusion defects are associated with corresponding wall-motion abnormalities. Additional study is necessary to better define the long-term functional consequences of RT-induced perfusion defects.
Authors:
Lawrence B Marks; Xiaoli Yu; Robert G Prosnitz; Su-Min Zhou; Patricia H Hardenbergh; Michael Blazing; Donna Hollis; Pehr Lind; Andrea Tisch; Terence Z Wong; Salvador Borges-Neto
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  63     ISSN:  0360-3016     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-22     Completed Date:  2005-10-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  214-23     Citation Subset:  IM    
Affiliation:
Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA. marks@radonc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Breast Neoplasms / pathology,  physiopathology,  radiotherapy*
Coronary Circulation / physiology,  radiation effects
Female
Heart / physiopathology,  radiation effects*,  radionuclide imaging
Humans
Middle Aged
Myocardial Contraction / physiology,  radiation effects*
Prospective Studies
Radiation Dosage
Radiation Injuries / physiopathology*,  radionuclide imaging
Stroke Volume / physiology,  radiation effects
Tomography, Emission-Computed, Single-Photon
Comments/Corrections
Comment In:
Int J Radiat Oncol Biol Phys. 2006 Mar 15;64(4):1287; author reply 1287-8   [PMID:  16504767 ]

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