Limits...
Troponin T-release associates with cardiac radiation doses during adjuvant left-sided breast cancer radiotherapy.

Skyttä T, Tuohinen S, Boman E, Virtanen V, Raatikainen P, Kellokumpu-Lehtinen PL - Radiat Oncol (2015)

Bottom Line: For the heart, no safe radiation threshold has been established.For the left anterior descending artery (LAD), differences between groups A and B were found in volumes receiving 15 Gy (p = 0.03) and 20 Gy (p = 0.03) Furthermore, after RT, the interventricular septum thickened (p = 0.01), and the deceleration time was prolonged (p = 0.008) more in group A than in group B.Whether these acute subclinical changes increase the risk of excessive long-term cardiovascular morbidity or mortality, will be addressed in the follow-up of our patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology and School of Medicine, Tampere University Hospital, University of Tampere, 33521, Tampere, Finland. tanja.skytta@pshp.fi.

ABSTRACT

Background: Adjuvant radiotherapy (RT) for left-sided breast cancer increases cardiac morbidity and mortality. For the heart, no safe radiation threshold has been established. Troponin T is a sensitive marker of myocardial damage. Our aim was to evaluate the effect of left-sided breast cancer RT on serum high sensitivity troponin T (hscTnT) levels and its association with cardiac radiation doses and echocardiographic parameters.

Methods: A total of 58 patients with an early stage, left-sided breast cancer or ductal carcinoma in situ (DCIS) who received adjuvant breast RT without prior chemotherapy were included in this prospective, non-randomized study. Serum samples were taken before, during and after RT. An increase of hscTnT >30 % was predefined as significant. A comprehensive 2D echocardiograph and electrocardiogram (ECG) were performed before and after RT. Dose-volume histograms (DVHs) were generated for different cardiac structures.

Results: The hscTnT increased during RT from baseline in 12/58 patients (21 %). Patients with increased hscTnT values (group A, N = 12) had significantly higher radiation doses for the whole heart (p = 0.02) and left ventricle (p = 0.03) than patients without hscTnT increase (group B, N = 46). For the left anterior descending artery (LAD), differences between groups A and B were found in volumes receiving 15 Gy (p = 0.03) and 20 Gy (p = 0.03) Furthermore, after RT, the interventricular septum thickened (p = 0.01), and the deceleration time was prolonged (p = 0.008) more in group A than in group B.

Conclusions: The increase in hscTnT level during adjuvant RT was positively associated with the cardiac radiation doses for the whole heart and LV in chemotherapy-naive breast cancer patients. Whether these acute subclinical changes increase the risk of excessive long-term cardiovascular morbidity or mortality, will be addressed in the follow-up of our patients.

No MeSH data available.


Related in: MedlinePlus

Dose volume histogram (DVH) curves for left anterior descending artery (LAD), heart and left ventricle (LV) in patients with increased high sensitivity cardiac troponin T (hscTnT) release (Group A, N = 12) and in patients without hscTnT release (Group B, N = 46)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4496940&req=5

Fig2: Dose volume histogram (DVH) curves for left anterior descending artery (LAD), heart and left ventricle (LV) in patients with increased high sensitivity cardiac troponin T (hscTnT) release (Group A, N = 12) and in patients without hscTnT release (Group B, N = 46)

Mentions: The DVH curves for the both groups are presented in Fig. 2. The AUC for heart and left ventricle was significantly higher in the hscTnT-positive group A compared with group B (p < 0.05, Table 2). The same trend was seen for the LAD (p = 0.08). In addition to AUC, some relevant dose-volume parameters (volume of structure receiving 5 Gy radiation dose = V5 and similarly V10, V15, V20 and V30) were separately tested (Fig. 2 and Table 2). In the heart and left ventricle, the difference between groups was significant in all those Gy points from 5 to 20 Gy, but in the LAD the difference between groups was significant only at dose levels of 15 and 20 Gy.Fig. 2


Troponin T-release associates with cardiac radiation doses during adjuvant left-sided breast cancer radiotherapy.

Skyttä T, Tuohinen S, Boman E, Virtanen V, Raatikainen P, Kellokumpu-Lehtinen PL - Radiat Oncol (2015)

Dose volume histogram (DVH) curves for left anterior descending artery (LAD), heart and left ventricle (LV) in patients with increased high sensitivity cardiac troponin T (hscTnT) release (Group A, N = 12) and in patients without hscTnT release (Group B, N = 46)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4496940&req=5

Fig2: Dose volume histogram (DVH) curves for left anterior descending artery (LAD), heart and left ventricle (LV) in patients with increased high sensitivity cardiac troponin T (hscTnT) release (Group A, N = 12) and in patients without hscTnT release (Group B, N = 46)
Mentions: The DVH curves for the both groups are presented in Fig. 2. The AUC for heart and left ventricle was significantly higher in the hscTnT-positive group A compared with group B (p < 0.05, Table 2). The same trend was seen for the LAD (p = 0.08). In addition to AUC, some relevant dose-volume parameters (volume of structure receiving 5 Gy radiation dose = V5 and similarly V10, V15, V20 and V30) were separately tested (Fig. 2 and Table 2). In the heart and left ventricle, the difference between groups was significant in all those Gy points from 5 to 20 Gy, but in the LAD the difference between groups was significant only at dose levels of 15 and 20 Gy.Fig. 2

Bottom Line: For the heart, no safe radiation threshold has been established.For the left anterior descending artery (LAD), differences between groups A and B were found in volumes receiving 15 Gy (p = 0.03) and 20 Gy (p = 0.03) Furthermore, after RT, the interventricular septum thickened (p = 0.01), and the deceleration time was prolonged (p = 0.008) more in group A than in group B.Whether these acute subclinical changes increase the risk of excessive long-term cardiovascular morbidity or mortality, will be addressed in the follow-up of our patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Oncology and School of Medicine, Tampere University Hospital, University of Tampere, 33521, Tampere, Finland. tanja.skytta@pshp.fi.

ABSTRACT

Background: Adjuvant radiotherapy (RT) for left-sided breast cancer increases cardiac morbidity and mortality. For the heart, no safe radiation threshold has been established. Troponin T is a sensitive marker of myocardial damage. Our aim was to evaluate the effect of left-sided breast cancer RT on serum high sensitivity troponin T (hscTnT) levels and its association with cardiac radiation doses and echocardiographic parameters.

Methods: A total of 58 patients with an early stage, left-sided breast cancer or ductal carcinoma in situ (DCIS) who received adjuvant breast RT without prior chemotherapy were included in this prospective, non-randomized study. Serum samples were taken before, during and after RT. An increase of hscTnT >30 % was predefined as significant. A comprehensive 2D echocardiograph and electrocardiogram (ECG) were performed before and after RT. Dose-volume histograms (DVHs) were generated for different cardiac structures.

Results: The hscTnT increased during RT from baseline in 12/58 patients (21 %). Patients with increased hscTnT values (group A, N = 12) had significantly higher radiation doses for the whole heart (p = 0.02) and left ventricle (p = 0.03) than patients without hscTnT increase (group B, N = 46). For the left anterior descending artery (LAD), differences between groups A and B were found in volumes receiving 15 Gy (p = 0.03) and 20 Gy (p = 0.03) Furthermore, after RT, the interventricular septum thickened (p = 0.01), and the deceleration time was prolonged (p = 0.008) more in group A than in group B.

Conclusions: The increase in hscTnT level during adjuvant RT was positively associated with the cardiac radiation doses for the whole heart and LV in chemotherapy-naive breast cancer patients. Whether these acute subclinical changes increase the risk of excessive long-term cardiovascular morbidity or mortality, will be addressed in the follow-up of our patients.

No MeSH data available.


Related in: MedlinePlus