乳腺癌放疗后与癌症治疗相关的心脏功能障碍:BACCARAT 队列研究的结果。

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
M K Honaryar, M Locquet, R Allodji, G Jimenez, B Pinel, O Lairez, L Panh, J Camilleri, D Broggio, J Ferrières, F De Vathaire, S Jacob
{"title":"乳腺癌放疗后与癌症治疗相关的心脏功能障碍:BACCARAT 队列研究的结果。","authors":"M K Honaryar, M Locquet, R Allodji, G Jimenez, B Pinel, O Lairez, L Panh, J Camilleri, D Broggio, J Ferrières, F De Vathaire, S Jacob","doi":"10.1186/s40959-024-00255-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Radiation therapy (RT) for breast cancer (BC) can result in subtle cardiac dysfunction that can occur early after treatment. In 2022, the European Society of Cardiology (ESC) published the first guidelines in cardio-oncology with a harmonized definition of cancer therapy-related cardiac dysfunction (CTRCD). The aim of this study was to evaluate CTRCD occurrence over 24 months of follow-up after RT in BC patients and to analyze the association with cardiac radiation exposure.</p><p><strong>Methods: </strong>The prospective monocentric BACCARAT study included BC patients treated with RT without chemotherapy, aged 40-75 years, with conventional and 2D Speckle tracking echocardiography performed before RT, 6 and 24 months after RT. Based on ESC cardio-oncology guidelines, CTRCD and corresponding severity were defined with left ventricle ejection fraction and global longitudinal strain decrease, occurring at 6 or 24 months after RT. Dosimetry for whole heart, left ventricle (LV) and left coronary artery (left anterior descending and circumflex arteries (CX)) was considered to evaluate the association with CTRCD, based on logistic regressions (Odds Ratio - OR and 95% confidence interval - 95%CI). Youden index based on receiver operating characteristic curve analysis was used to identify the optimal threshold of dose-volume parameters for predicting CTRCD.</p><p><strong>Results: </strong>The study included 72 BC patients with a mean age of 58 ± 8.2 years. A total of 32 (44%) patients developed CTRCD during follow-up: 20 (28%) mild CTRCD, 7 (9%) moderate CTRCD, and 5 (7%) severe CTRCD. Cardiac radiation doses were generally higher among patients with CTRCD rather than non-CTRCD. Dose-response relationships were significant for mean CX dose (OR = 2.48, 95%CI (1.12-5.51), p = 0.02) and marginally significant for V2 of LV (OR = 1.03 95%CI (1.00-1.06), p = 0.05). V2 of LV ≥ 36% and mean CX dose ≥ 1.40 Gy thresholds were determined to be optimal for predicting CTRCD.</p><p><strong>Conclusion: </strong>For BC patients treated with RT without chemotherapy, CTRCD can be observed in an important proportion of the population over 24 months after treatment. Left ventricle and circumflex coronary artery exposure were found to be associated with CTRCD and could be used for the prediction of such cardiotoxicity. Further research remains needed to confirm these results.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier- NCT02605512.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345963/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cancer therapy-related cardiac dysfunction after radiation therapy for breast cancer: results from the BACCARAT cohort study.\",\"authors\":\"M K Honaryar, M Locquet, R Allodji, G Jimenez, B Pinel, O Lairez, L Panh, J Camilleri, D Broggio, J Ferrières, F De Vathaire, S Jacob\",\"doi\":\"10.1186/s40959-024-00255-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Radiation therapy (RT) for breast cancer (BC) can result in subtle cardiac dysfunction that can occur early after treatment. In 2022, the European Society of Cardiology (ESC) published the first guidelines in cardio-oncology with a harmonized definition of cancer therapy-related cardiac dysfunction (CTRCD). The aim of this study was to evaluate CTRCD occurrence over 24 months of follow-up after RT in BC patients and to analyze the association with cardiac radiation exposure.</p><p><strong>Methods: </strong>The prospective monocentric BACCARAT study included BC patients treated with RT without chemotherapy, aged 40-75 years, with conventional and 2D Speckle tracking echocardiography performed before RT, 6 and 24 months after RT. Based on ESC cardio-oncology guidelines, CTRCD and corresponding severity were defined with left ventricle ejection fraction and global longitudinal strain decrease, occurring at 6 or 24 months after RT. Dosimetry for whole heart, left ventricle (LV) and left coronary artery (left anterior descending and circumflex arteries (CX)) was considered to evaluate the association with CTRCD, based on logistic regressions (Odds Ratio - OR and 95% confidence interval - 95%CI). Youden index based on receiver operating characteristic curve analysis was used to identify the optimal threshold of dose-volume parameters for predicting CTRCD.</p><p><strong>Results: </strong>The study included 72 BC patients with a mean age of 58 ± 8.2 years. A total of 32 (44%) patients developed CTRCD during follow-up: 20 (28%) mild CTRCD, 7 (9%) moderate CTRCD, and 5 (7%) severe CTRCD. Cardiac radiation doses were generally higher among patients with CTRCD rather than non-CTRCD. Dose-response relationships were significant for mean CX dose (OR = 2.48, 95%CI (1.12-5.51), p = 0.02) and marginally significant for V2 of LV (OR = 1.03 95%CI (1.00-1.06), p = 0.05). V2 of LV ≥ 36% and mean CX dose ≥ 1.40 Gy thresholds were determined to be optimal for predicting CTRCD.</p><p><strong>Conclusion: </strong>For BC patients treated with RT without chemotherapy, CTRCD can be observed in an important proportion of the population over 24 months after treatment. Left ventricle and circumflex coronary artery exposure were found to be associated with CTRCD and could be used for the prediction of such cardiotoxicity. Further research remains needed to confirm these results.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier- NCT02605512.</p>\",\"PeriodicalId\":9804,\"journal\":{\"name\":\"Cardio-oncology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-08-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345963/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardio-oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s40959-024-00255-9\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardio-oncology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s40959-024-00255-9","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

摘要

背景:乳腺癌(BC)的放射治疗(RT)可导致微妙的心功能障碍,这种障碍可在治疗后早期出现。2022 年,欧洲心脏病学会(ESC)发布了第一份心肿瘤学指南,对癌症治疗相关心功能不全(CTRCD)进行了统一定义。本研究旨在评估BC患者接受RT治疗后24个月随访期间的CTRCD发生率,并分析其与心脏辐射暴露的关系:前瞻性单中心 BACCARAT 研究纳入了接受 RT 无化疗治疗的 BC 患者,年龄在 40-75 岁之间,在 RT 前、RT 后 6 个月和 24 个月分别进行了常规和二维斑点追踪超声心动图检查。根据ESC心肿瘤学指南,CTRCD及其相应严重程度的定义为左心室射血分数和整体纵向应变下降,发生在RT后6个月或24个月。全心、左心室(LV)和左冠状动脉(左前降支和环状动脉(CX))的剂量测定基于逻辑回归(Odds Ratio - OR和95%置信区间 - 95%CI)来评估与CTRCD的相关性。基于接收者操作特征曲线分析的尤登指数用于确定预测 CTRCD 的最佳剂量-体积参数阈值:研究共纳入 72 例 BC 患者,平均年龄为 58 ± 8.2 岁。共有 32 例(44%)患者在随访期间出现了 CTRCD:20 例(28%)为轻度 CTRCD,7 例(9%)为中度 CTRCD,5 例(7%)为重度 CTRCD。CTRCD患者的心脏辐射剂量普遍高于非CTRCD患者。剂量-反应关系对平均 CX 剂量显著(OR = 2.48,95%CI (1.12-5.51),p = 0.02),对左心室 V2 稍微显著(OR = 1.03 95%CI (1.00-1.06),p = 0.05)。LV的V2≥36%和平均CX剂量≥1.40 Gy阈值被确定为预测CTRCD的最佳值:结论:对于接受RT治疗而未接受化疗的BC患者,在治疗后24个月内可观察到很大一部分患者出现CTRCD。研究发现,左心室和冠状动脉环暴露与 CTRCD 相关,可用于预测此类心脏毒性。要证实这些结果,仍需进一步研究:试验注册:ClinicalTrials.gov Identifier- NCT02605512。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cancer therapy-related cardiac dysfunction after radiation therapy for breast cancer: results from the BACCARAT cohort study.

Background: Radiation therapy (RT) for breast cancer (BC) can result in subtle cardiac dysfunction that can occur early after treatment. In 2022, the European Society of Cardiology (ESC) published the first guidelines in cardio-oncology with a harmonized definition of cancer therapy-related cardiac dysfunction (CTRCD). The aim of this study was to evaluate CTRCD occurrence over 24 months of follow-up after RT in BC patients and to analyze the association with cardiac radiation exposure.

Methods: The prospective monocentric BACCARAT study included BC patients treated with RT without chemotherapy, aged 40-75 years, with conventional and 2D Speckle tracking echocardiography performed before RT, 6 and 24 months after RT. Based on ESC cardio-oncology guidelines, CTRCD and corresponding severity were defined with left ventricle ejection fraction and global longitudinal strain decrease, occurring at 6 or 24 months after RT. Dosimetry for whole heart, left ventricle (LV) and left coronary artery (left anterior descending and circumflex arteries (CX)) was considered to evaluate the association with CTRCD, based on logistic regressions (Odds Ratio - OR and 95% confidence interval - 95%CI). Youden index based on receiver operating characteristic curve analysis was used to identify the optimal threshold of dose-volume parameters for predicting CTRCD.

Results: The study included 72 BC patients with a mean age of 58 ± 8.2 years. A total of 32 (44%) patients developed CTRCD during follow-up: 20 (28%) mild CTRCD, 7 (9%) moderate CTRCD, and 5 (7%) severe CTRCD. Cardiac radiation doses were generally higher among patients with CTRCD rather than non-CTRCD. Dose-response relationships were significant for mean CX dose (OR = 2.48, 95%CI (1.12-5.51), p = 0.02) and marginally significant for V2 of LV (OR = 1.03 95%CI (1.00-1.06), p = 0.05). V2 of LV ≥ 36% and mean CX dose ≥ 1.40 Gy thresholds were determined to be optimal for predicting CTRCD.

Conclusion: For BC patients treated with RT without chemotherapy, CTRCD can be observed in an important proportion of the population over 24 months after treatment. Left ventricle and circumflex coronary artery exposure were found to be associated with CTRCD and could be used for the prediction of such cardiotoxicity. Further research remains needed to confirm these results.

Trial registration: ClinicalTrials.gov Identifier- NCT02605512.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Cardio-oncology
Cardio-oncology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
5.00
自引率
3.00%
发文量
17
审稿时长
7 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信