背景:据报道,冠状动脉疾病(CAD)是早期乳腺癌(BC)放射治疗(RT)后的晚期效应。这项研究旨在报告接受基于CT的RT治疗的患者的心脏和心脏亚结构的单个RT剂量,并研究使用现代放射治疗技术是否存在RT剂量与CAD之间的剂量反应关系。
方法:2005年至2016年在丹麦乳腺癌组数据库中注册的基于CT的RT的患者符合资格。在15765名患者中,本研究包括204例照射后CAD患者(病例)和408例匹配对照.检索到个人计划CT,描绘心脏和心脏亚结构,并提取剂量-体积参数。
结果:中位随访时间为7.3年(IQR:4.6-10.0)。在案件中,左侧和右侧患者的中位平均心脏剂量为1.6Gy(IQR0.2-6.1)和0.8Gy(0.1-2.9),分别(p<0.001)。在左侧RT的左心室和左冠状动脉前降支以及右侧RT后的右心房和右冠状动脉中观察到最高的RT剂量。最高的左-右剂量差位于左冠状动脉前降支的远端部分,在那里也观察到最高的左-右事件比。然而,通过侧向没有观察到CAD分布的显着差异。此外,病例与对照组相比,剂量-体积参数无显著差异.
结论:CAD倾向于发生在左-右剂量差异最高的心脏部位,然而,中位随访7年,未观察到显著的CAD风险.
Coronary artery disease (CAD) has been reported as a late effect following radiation therapy (RT) of early breast cancer (BC). This
study aims to report individual RT doses to the heart and cardiac substructures in patients treated with CT-based RT and to investigate if a dose-response relationship between RT dose and CAD exists using modern radiation therapy techniques.
Patients registered in the Danish Breast Cancer Group database from 2005 to 2016 with CT-based RT were eligible. Among 15,765 patients, the
study included 204 with CAD after irradiation (cases) and 408 matched controls. Individual planning CTs were retrieved, the heart and cardiac substructures were delineated and dose-volume parameters were extracted.
The median follow-up time was 7.3 years (IQR: 4.6-10.0). Among cases, the median mean heart dose was 1.6 Gy (IQR 0.2-6.1) and 0.8 Gy (0.1-2.9) for left-sided and right-sided patients, respectively (p < 0.001). The highest RT doses were observed in the left ventricle and left anterior descending coronary artery for left-sided RT and in the right atrium and the right coronary artery after right-sided RT. The highest left-minus-right dose-difference was located in the distal part of the left anterior descending coronary artery where also the highest left-versus-right ratio of events was observed. However, no significant difference in the distribution of CAD was observed by laterality. Furthermore, no significant differences in the dose-volume parameters were observed for cases versus controls.
CAD tended to occur in the part of the heart with the highest left-minus- right dose difference, however, no significant risk of CAD was observed at 7 years\' median follow-up.