Evaluation of Myocardial Function Before Radiotherapy for Breast Cancer Patients

評估乳癌患者放射治療前之心肌功能程度

余志薇(Chih-Wei Yu) ； 楊舒雅(Shu-Ya Yang) ； 林冠亨(Kuan-Heng Lin) ； 熊佩韋(Pei-Wei Shueng) ； 吳彥雯(Yen-Wen Wu) ； 吳東信(Tung-Hsin Wu) ； 徐晨雄(Chen-Xiong Hsu) ； 汪姍瑩(Shan-Ying Wang)

《核子醫學暨分子影像雜誌》 33卷2期 (2020/06) Pp. 80-87

https://doi.org/10.6332/ANMMI.202006_33(2).0002

摘要

Background: Radiotherapy (RT) and chemotherapy can improve tumor control for breast cancer (BC). Whether it is chemotherapy or RT, they may increase the incidence of cardiotoxicity and may cause complications, such as cardiovascular disease, myocardial perfusion defect, or life-threatening heart failure. Previous studies demonstrated that single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) can early detect myocardial dysfunction caused after treatment. Therefore, in order to comprehend the cardiac function of before RT for BC patients, this study aims to retrospectively collect cardiac function indexes of BC patients before RT and analyze the difference between with and without chemotherapy patients. Methods: This retrospective study included 49 left BC patients who received SPECT MPI before RT, and record wall motion (WM), wall thickening (WT), motion scores, and thickening scores. The cardiac function indexes between with and without chemotherapy were analyzed. Results: Preliminary results showed that 32 patients were with chemotherapy and 17 patients were without chemotherapy. The WM was 8.21 ± 2.30 mm and 8.55 ± 2.21 mm (p = 0.502) respectively; the WT was 50.58 ± 21.04% and 54.51 ± 20.82% (p = 0.488). Besides, there was WM abnormality (motion scores ≥ 2) with chemotherapy patients in segments 2, 3, 4, 5, 6, 8, 9, and 12 and without chemotherapy patients in segments 2, 3, 4, and 8. After chemotherapy, patients with thickening abnormalities (thickening scores ≥ 2) were in segments 2, 3, 4, 5, 6, and 8; patients without chemotherapy were in segment 3. Conclusions: This retrospective study found that patients with chemotherapy were reducing the cardiac function. Therefore, when the patients receive the following RT, the radiation dose of the heart needs to be noticed because of chemotherapy.

關鍵字

breast cancer ； radiotherapy ； single photon emission computed tomography (SPECT)

並列摘要

背景：乳癌患者能透過接受化學治療及放射治療以提升腫瘤控制率，但不論是化療或是放療中皆有可能增加心臟毒性的發生機率，進而產生併發症，如心血管疾病、心肌功能缺損，甚至是心臟衰竭，嚴重者會危及生命。有文獻指出透過單光子電腦斷層掃描之心肌灌注造影（single photon emission computed tomography myocardial perfusion imaging, SPECT MPI）可早期偵測治療所導致之心肌功能異常。因此，為能於放射治療前瞭解患者心臟功能狀況，本研究回溯收集左側乳癌患者於放射治療前之各項心臟功能指標，並分析有無接受化學治療之兩組患者的指標差異。方法：本研究回溯收集49位左側乳癌患者之放射治療前單光子電腦斷層掃描之心肌灌注影像，並記錄SPECT MPI之wall motion（WM）、wall thickening（WT）、motion scores及thickening scores等心臟功能指標。統計分區心臟之異常數，並分析有無接受化學治療之兩組患者的指標差異。結果：初步結果顯示32位有接受化療之患者及17位無接受化療之患者，有接受化療及無接受化療患者之WM分別為8.21 ± 2.30 mm及8.55 ± 2.21mm（p = 0.502）；WT分別為50.58 ± 21.04 % 及54.51 ± 20.82 %（p = 0.488）。此外，接受化療後患者motion有異常（motion scores ≥ 2）之區域為第2、3、4、5、6、8、9及12區；無接受化療之患者則在第2、3、4及8區。接受化療後患者有thickening異常（thickening scores ≥ 2）之區域為第2、3、4、5、6及8區；無接受化療之患者則在第3區。結論：本研究回溯分析發現接受化療之患者的心功能相對較差。因此，在後續進行放射治療時，對於已接受化療之患者應更加注意輻射劑量對於心臟之影響。

並列關鍵字

放射治療 ； 乳癌 ； 單光子電腦斷層