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Choi W, Jia Y, Kwak J, Werner-Wasik M, Dicker AP, Simone NL, Storozynsky E, Jain V, Vinogradskiy Y. Novel Functional Radiomics for Prediction of Cardiac Positron Emission Tomography Avidity in Lung Cancer Radiotherapy. JCO Clin Cancer Inform 2024; 8:e2300241. [PMID: 38452302 PMCID: PMC10939651 DOI: 10.1200/cci.23.00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Traditional methods of evaluating cardiotoxicity focus on radiation doses to the heart. Functional imaging has the potential to provide improved prediction for cardiotoxicity for patients with lung cancer. Fluorine-18 (18F) fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) imaging is routinely obtained in a standard cancer staging workup. This work aimed to develop a radiomics model predicting clinical cardiac assessment using 18F-FDG PET/CT scans before thoracic radiation therapy. METHODS Pretreatment 18F-FDG PET/CT scans from three study populations (N = 100, N = 39, N = 70) were used, comprising two single-institutional protocols and one publicly available data set. A clinician (V.J.) classified the PET/CT scans per clinical cardiac guidelines as no uptake, diffuse uptake, or focal uptake. The heart was delineated, and 210 novel functional radiomics features were selected to classify cardiac FDG uptake patterns. Training data were divided into training (80%)/validation (20%) sets. Feature reduction was performed using the Wilcoxon test, hierarchical clustering, and recursive feature elimination. Ten-fold cross-validation was carried out for training, and the accuracy of the models to predict clinical cardiac assessment was reported. RESULTS From 202 of 209 scans, cardiac FDG uptake was scored as no uptake (39.6%), diffuse uptake (25.3%), and focal uptake (35.1%), respectively. Sixty-two independent radiomics features were reduced to nine clinically pertinent features. The best model showed 93% predictive accuracy in the training data set and 80% and 92% predictive accuracy in two external validation data sets. CONCLUSION This work used an extensive patient data set to develop a functional cardiac radiomic model from standard-of-care 18F-FDG PET/CT scans, showing good predictive accuracy. The radiomics model has the potential to provide an automated method to predict existing cardiac conditions and provide an early functional biomarker to identify patients at risk of developing cardiac complications after radiotherapy.
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Affiliation(s)
- Wookjin Choi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Yingcui Jia
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jennifer Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Adam P. Dicker
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Nicole L. Simone
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Eugene Storozynsky
- Department of Cardiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Varsha Jain
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Eber J, Blondet C, Le Fevre C, Chambrelant I, Hubele F, Morel O, Antoni D, Noel G. Nuclear medicine imaging methods of early radiation-induced cardiotoxicity: a ten-year systematic review. Front Oncol 2023; 13:1240889. [PMID: 37876964 PMCID: PMC10591197 DOI: 10.3389/fonc.2023.1240889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Radiotherapy has significantly improved cancer survival rates, but it also comes with certain unavoidable complications. Breast and thoracic irradiation, for instance, can unintentionally expose the heart to radiation, leading to damage at the cellular level within the myocardial structures. Detecting and monitoring radiation-induced heart disease early on is crucial, and several radionuclide imaging techniques have shown promise in this regard. Method In this 10-year review, we aimed to identify nuclear medicine imaging modalities that can effectively detect early cardiotoxicity following radiation therapy. Through a systematic search on PubMed, we selected nineteen relevant studies based on predefined criteria. Results The data suggest that incidental irradiation of the heart during breast or thoracic radiotherapy can cause early metabolic and perfusion changes. Nuclear imaging plays a prominent role in detecting these subclinical effects, which could potentially serve as predictors of late cardiac complications. Discussion However, further studies with larger populations, longer follow-up periods, and specific heart dosimetric data are needed to better understand the relationship between early detection of cardiac abnormalities and radiation-induced heart disease.
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Affiliation(s)
- Jordan Eber
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Cyrille Blondet
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Nuclear Medicine, Strasbourg, France
| | - Clara Le Fevre
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Isabelle Chambrelant
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Fabrice Hubele
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Nuclear Medicine, Strasbourg, France
| | - Olivier Morel
- Nouvel Hôpital Civil, Department of Cardiology, Strasbourg, France
| | - Delphine Antoni
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
| | - Georges Noel
- Institut de Cancérologie Strasbourg Europe (ICANS), Department of Radiation Oncology, Strasbourg, France
- Strasbourg University, Institut Centre national de la recherche scientifique (CNRS), Institut Pluridisciplinaire Hubert Curien (IPHC) UMR 7178, Centre Paul Strauss, UNICANCER, Strasbourg, France
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3
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Zakem SJ, Jones B, Castillo R, Castillo E, Miften M, Goodman KA, Schefter T, Olsen J, Vinogradskiy Y. Cardiac metabolic changes on 18 F-positron emission tomography after thoracic radiotherapy predict for overall survival in esophageal cancer patients. J Appl Clin Med Phys 2023; 24:e13552. [PMID: 35243772 PMCID: PMC10476995 DOI: 10.1002/acm2.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/04/2022] [Accepted: 01/19/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Heart doses have been shown to be predictive of cardiac toxicity and overall survival (OS) for esophageal cancer patients. There is potential for functional imaging to provide valuable cardiac information. The purpose of this study was to evaluate the cardiac metabolic dose-response using 18 F-deoxyglucose (FDG)-PET and to assess whether standard uptake value (SUV) changes in the heart were predictive of OS. METHODS Fifty-one patients with esophageal cancer treated with radiation who underwent pre- and post-treatment FDG-PET scans were retrospectively evaluated. Pre- and post-treatment PET-scans were rigidly registered to the planning CT for each patient. Pre-treatment to post-treatment absolute mean SUV (SUVmean) changes in the heart were calculated to assess dose-response. A dose-response curve was generated by binning each voxel in the heart into 10 Gy dose-bins and analyzing the SUVmean changes in each dose-bin. Multivariate cox proportional hazard models were used to assess whether pre-to-post treatment cardiac SUVmean changes predicted for OS. RESULTS The cardiac dose-response curve demonstrated a trend of increasing cardiac SUV changes as a function of dose with an average increase of 0.044 SUV for every 10 Gy dose bin. In multivariate analysis, disease stage and SUVmean change in the heart were predictive (p < 0.05) for OS. CONCLUSIONS Changes in pre- to post-treatment cardiac SUV were predictive of OS with patients having a higher pre- to post-treatment cardiac SUV change surviving longer.
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Affiliation(s)
- Sara J Zakem
- Department of Radiation OncologyUniversity of WashingtonSeattleWashingtonUSA
| | - Bernard Jones
- Department of Radiation OncologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Richard Castillo
- Department of Radiation OncologyEmory UniversityAtlantaGeorgiaUSA
| | - Edward Castillo
- Department of Radiation OncologyBeaumont HealthRoyal OakMichiganUSA
| | - Moyed Miften
- Department of Radiation OncologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Karyn A Goodman
- Department of Radiation OncologyMount SinaiNew YorkNew YorkUSA
| | - Tracey Schefter
- Department of Radiation OncologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jeffrey Olsen
- Department of Radiation OncologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Yevgeniy Vinogradskiy
- Department of Radiation OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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4
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Mikail N, Chequer R, Imperiale A, Meisel A, Bengs S, Portmann A, Gimelli A, Buechel RR, Gebhard C, Rossi A. Tales from the future-nuclear cardio-oncology, from prediction to diagnosis and monitoring. Eur Heart J Cardiovasc Imaging 2023; 24:1129-1145. [PMID: 37467476 PMCID: PMC10501471 DOI: 10.1093/ehjci/jead168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023] Open
Abstract
Cancer and cardiovascular diseases (CVD) often share common risk factors, and patients with CVD who develop cancer are at high risk of experiencing major adverse cardiovascular events. Additionally, cancer treatment can induce short- and long-term adverse cardiovascular events. Given the improvement in oncological patients' prognosis, the burden in this vulnerable population is slowly shifting towards increased cardiovascular mortality. Consequently, the field of cardio-oncology is steadily expanding, prompting the need for new markers to stratify and monitor the cardiovascular risk in oncological patients before, during, and after the completion of treatment. Advanced non-invasive cardiac imaging has raised great interest in the early detection of CVD and cardiotoxicity in oncological patients. Nuclear medicine has long been a pivotal exam to robustly assess and monitor the cardiac function of patients undergoing potentially cardiotoxic chemotherapies. In addition, recent radiotracers have shown great interest in the early detection of cancer-treatment-related cardiotoxicity. In this review, we summarize the current and emerging nuclear cardiology tools that can help identify cardiotoxicity and assess the cardiovascular risk in patients undergoing cancer treatments and discuss the specific role of nuclear cardiology alongside other non-invasive imaging techniques.
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Affiliation(s)
- Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Renata Chequer
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018 Paris, France
| | - Alessio Imperiale
- Nuclear Medicine, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67093 Strasbourg, France
- Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, 67093 Strasbourg, France
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Kantonsspital Glarus, Burgstrasse 99, 8750 Glarus, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Alessia Gimelli
- Imaging Department, Fondazione CNR/Regione Toscana Gabriele Monasterio, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Cathérine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
- Department of Cardiology, University Hospital Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
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Eber J, Schmitt M, Dehaynin N, Le Fèvre C, Antoni D, Noël G. Evaluation of Cardiac Substructures Exposure of DIBH-3DCRT, FB-HT, and FB-3DCRT in Hypofractionated Radiotherapy for Left-Sided Breast Cancer after Breast-Conserving Surgery: An In Silico Planning Study. Cancers (Basel) 2023; 15:3406. [PMID: 37444516 DOI: 10.3390/cancers15133406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Left-sided breast cancer radiotherapy can lead to late cardiovascular complications, including ischemic events. To mitigate these risks, cardiac-sparing techniques such as deep-inspiration breath-hold (DIBH) and intensity-modulated radiotherapy (IMRT) have been developed. However, recent studies have shown that mean heart dose is not a sufficient dosimetric parameter for assessing cardiac exposure. In this study, we aimed to compare the radiation exposure to cardiac substructures for ten patients who underwent hypofractionated radiotherapy using DIBH three-dimensional conformal radiation therapy (3DCRT), free-breathing (FB)-3DCRT, and FB helical tomotherapy (HT). Dosimetric parameters of cardiac substructures were analyzed, and the results were statistically compared using the Wilcoxon signed-rank test. This study found a significant reduction in the dose to the heart, left anterior descending coronary artery, and ventricles with DIBH-3DCRT and FB-HT compared to FB-3DCRT. While DIBH-3DCRT was very effective in sparing the heart, in some cases, it provided little or no cardiac sparing. FB-HT can be an interesting treatment modality to reduce the dose to major coronary vessels and ventricles and may be of interest for patients with cardiovascular risks who do not benefit from or cannot perform DIBH. These findings highlight the importance of cardiac-sparing techniques for precise delivery of radiation therapy.
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Affiliation(s)
- Jordan Eber
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Martin Schmitt
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Nicolas Dehaynin
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Clara Le Fèvre
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Delphine Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Georges Noël
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
- Centre Paul Strauss, Strasbourg University, CNRS, IPHC UMR 7178, UNICANCER, 67000 Strasbourg, France
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Chałubińska-Fendler J, Nowicka Z, Dróżdż I, Graczyk Ł, Piotrowski G, Tomasik B, Spych M, Fijuth J, Papis-Ubych A, Kędzierawski P, Kozono D, Fendler W. Radiation-induced circulating microRNAs linked to echocardiography parameters after radiotherapy. Front Oncol 2023; 13:1150979. [PMID: 37274244 PMCID: PMC10232985 DOI: 10.3389/fonc.2023.1150979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Patients treated with radiotherapy to the chest region are at risk of cardiac sequelae, however, identification of those with greatest risk of complications remains difficult. Here, we sought to determine whether short-term changes in circulating miRNA expression are related to measures of cardiac dysfunction in follow-up. Materials and methods Two parallel patient cohorts were enrolled and followed up for 3 years after completion of RT to treat left-sided breast cancer. In the primary group (N=28) we used a a panel of 752 miRNAs to identify miRNAs associated with radiation and cardiac indices at follow up. In the second, independent cohort (N=56) we validated those candidate miRNAs with a targeted qPCR panel. In both cohorts. serum samples were collected before RT, 24h after the last dose and 1 month after RT; cardiac echocardiography was performed 2.5-3 year after RT. Results Seven miRNAs in the primary group showed marked changes in serum miRNAs immediately after RT compared to baseline and associations with cardiopulmonary dose-volume histogram metrics. Among those miRNAs: miR-15b-5p, miR-22-3p, miR-424-5p and miR-451a were confirmed to show significant decrease of expression 24 hours post-RT in the validation cohort. Moreover, miR-29c, miR-451 and miR-424 were correlated with the end-diastolic diameter of the left ventricle, which was also confirmed in multivariable analysis adjusting for RT-associated factors. Conclusion We identified a subset of circulating miRNAs predictive for cardiac function impairment in patients treated for left-sided breast cancer, although longer clinical observation could determine if these can be used to predict major clinical endpoints.
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Affiliation(s)
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | - Izabela Dróżdż
- Department of Clinical Genetics, Medical University of Łódź, Łódź, Poland
| | - Łukasz Graczyk
- Department of Radiation Oncology, Oncology Center of Radom, Radom, Poland
- Department of Teleradiotherapy, Regional Cancer Centre, Copernicus Memorial Hospital of Łódź, Łódź, Poland
| | - Grzegorz Piotrowski
- Cardiooncology Department, Medical University of Lodz, Łódź, Poland
- Cardiology Department, Nicolaus Copernicus Memorial Hospital, Łódź, Poland
| | - Bartłomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Spych
- Department of Radiotherapy, Chair of Oncology, Medical University of Łódź, Łódź, Poland
| | - Jacek Fijuth
- Department of Teleradiotherapy, Regional Cancer Centre, Copernicus Memorial Hospital of Łódź, Łódź, Poland
- Department of Radiotherapy, Chair of Oncology, Medical University of Łódź, Łódź, Poland
| | - Anna Papis-Ubych
- Department of Teleradiotherapy, Regional Cancer Centre, Copernicus Memorial Hospital of Łódź, Łódź, Poland
| | | | - David Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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Tersalvi G, Beltrani V, Grübler MR, Molteni A, Cristoforetti Y, Pedrazzini G, Treglia G, Biasco L. Positron Emission Tomography in Heart Failure: From Pathophysiology to Clinical Application. J Cardiovasc Dev Dis 2023; 10:220. [PMID: 37233187 PMCID: PMC10218989 DOI: 10.3390/jcdd10050220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Imaging modalities are increasingly being used to evaluate the underlying pathophysiology of heart failure. Positron emission tomography (PET) is a non-invasive imaging technique that uses radioactive tracers to visualize and measure biological processes in vivo. PET imaging of the heart uses different radiopharmaceuticals to provide information on myocardial metabolism, perfusion, inflammation, fibrosis, and sympathetic nervous system activity, which are all important contributors to the development and progression of heart failure. This narrative review provides an overview of the use of PET imaging in heart failure, highlighting the different PET tracers and modalities, and discussing fields of present and future clinical application.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Vittorio Beltrani
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Martin R. Grübler
- Department of Cardiology, Regional Hospital Neustadt, 2700 Wiener Neustadt, Austria
- Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Alessandra Molteni
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Yvonne Cristoforetti
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Luigi Biasco
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, 10073 Ospedale di Ciriè, Italy
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Cai G, Li C, Li J, Yang J, Li C, Sun L, Li J, Yu J, Meng X. Cardiac Substructures Dosimetric Predictors for Cardiac Toxicity After Definitive Radiotherapy in Esophageal Cancer. Int J Radiat Oncol Biol Phys 2023; 115:366-381. [PMID: 35973623 DOI: 10.1016/j.ijrobp.2022.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/19/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate the predictive value of the cardiac substructures (CSs) dosimetric parameters for cardiac toxicity after definitive radiation therapy in locally advanced esophageal cancer. METHODS AND MATERIALS Between August 2010 and January 2016, 716 patients with stage 2-3 esophageal cancer receiving definitive radiation therapy at 2 institutions were divided into training (n = 432) and external validation (n = 284) cohorts. Dose-volume histogram parameters for the whole heart (WH) and CSs were extracted. Competing risks and Cox regressions analyses were performed. The predictive performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) and the Brier score. RESULTS With a median follow-up of 93 months, 68 patients (15.7%) developed grade ≥3 cardiac events (G3+ CEs), with a median of 13.5 months to the first event. Multivariable analysis showed left ventricle, left anterior descending (LAD), and mean left circumflex (LCX) variables were significantly associated with G3+ CEs. The AUCs and Brier scores demonstrated favorable predictive accuracies of the models integrating these CS variables when predicting G3+ CEs in the training and validation cohorts. However, compared with the WH variables, the CS variables did not significantly improve the prediction of G3+ CEs. Nevertheless, when G3+ acute coronary syndrome and/or congestive heart failure (ACS/CHF) CE was the outcome of interest, models based on the LAD or LCX variables were superior to the WH variable models in training and validation cohorts. CONCLUSIONS Models based on CS variables showed favorable predictive accuracy for G3+ CEs. The LAD and LCX variables significantly improved the prediction of G3+ ACS/CHF events compared with the WH variables. Radiation doses to CSs, such as LCX and LAD, should be monitored to help reduce the occurrence of significant CEs in patients with esophageal cancer undergoing definitive radiation therapy.
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Affiliation(s)
- Guoxin Cai
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Chuanbao Li
- Department of Emergency, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China; Department of Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jisheng Li
- Department of Medical Oncology, Cancer Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jianmin Yang
- Department of Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Chengming Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Liangchao Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jianing Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xue Meng
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
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FDG-PET findings associated with various medical procedures and treatments. Jpn J Radiol 2022; 41:459-476. [PMID: 36575286 PMCID: PMC9794480 DOI: 10.1007/s11604-022-01376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality with high sensitivity for the diagnosis and staging of oncologic patients. FDG is taken up by the glucose transporter of the cell membrane and becomes trapped within the cell. In addition to malignant neoplasms, active inflammatory lesions and some kinds of benign tumors also accumulate FDG. Moreover, the degree of uptake into normal organs and tissues depends on various physiological conditions, which is affected by various medical procedures, treatments, and drugs. To avoid misleading interpretations, it is important to recognize possible situations of unexpected abnormal accumulation that mimic tumor lesions. In this review, we present various FDG findings associated with surgical or medical procedures and treatments. Some findings reflect the expected physiological reaction to treatment, and some show inflammation due to prior procedures. Occasionally, FDG-PET visualizes other disorders that are unrelated to the malignancy, which may be associated with the adverse effects of certain drugs that the patient is taking. Careful review of medical records and detailed interviews of patients are thus necessary.
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10
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van der Ree MH, Dieleman EM, Visser J, Adam JA, de Bruin-Bon RH, de Jong RM, Hoeksema WF, Mosterd A, Balt JC, Planken RN, Balgobind BV, Postema PG. Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy-Refractory Ventricular Tachycardia Storm. Adv Radiat Oncol 2022; 7:100992. [PMID: 35782880 PMCID: PMC9240979 DOI: 10.1016/j.adro.2022.100992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/08/2022] [Indexed: 11/25/2022] Open
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11
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Changes in post-treatment cardiac PET avidity predict overall survival in lung cancer patients treated with chemoradiation: secondary analysis of the ACRIN 6668/RTOG 0235 clinical trial. Radiother Oncol 2022; 171:22-24. [DOI: 10.1016/j.radonc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/17/2022] [Accepted: 04/04/2022] [Indexed: 11/20/2022]
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12
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Abstract
PURPOSE OF REVIEW Successful treatment of cancer can be hampered by the attendant risk of cardiotoxicity, manifesting as cardiomyopathy, left ventricle systolic dysfunction and, in some cases, heart failure. This risk can be mitigated if the injury to the heart is detected before the onset to irreversible cardiac impairment. The gold standard for cardiac imaging in cardio-oncology is echocardiography. Despite improvements in the application of this modality, it is not typically sensitive to sub-clinical or early-stage dysfunction. We identify in this review some emerging tracers for detecting incipient cardiotoxicity by positron emission tomography (PET). RECENT FINDINGS Vectors labeled with positron-emitting radionuclides (e.g., carbon-11, fluorine-18, gallium-68) are now available to study cardiac function, metabolism, and tissue repair in preclinical models. Many of these probes are highly sensitive to early damage, thereby potentially addressing the limitations of current imaging approaches, and show promise in preliminary clinical evaluations. The overlapping pathophysiology between cardiotoxicity and heart failure significantly expands the number of imaging tools available to cardio-oncology. This is highlighted by the emergence of radiolabeled probes targeting fibroblast activation protein (FAP) for sensitive detection of dysregulated healing process that underpins adverse cardiac remodeling. The growth of PET scanner technology also creates an opportunity for a renaissance in metabolic imaging in cardio-oncology research.
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Affiliation(s)
- James M. Kelly
- Division of Radiopharmaceutical Sciences and Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, Belfer Research Building, Room BB-1604, 413 East 69th St, New York, NY 10021 USA
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY 10021 USA
| | - John W. Babich
- Division of Radiopharmaceutical Sciences and Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, Belfer Research Building, Room BB-1604, 413 East 69th St, New York, NY 10021 USA
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, NY 10021 USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10021 USA
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13
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Prediction of cardiac events following concurrent chemoradiation therapy for non-small-cell lung cancer using FDG PET. Ann Nucl Med 2022; 36:439-449. [PMID: 35175561 DOI: 10.1007/s12149-022-01724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE No imaging biomarkers are available for the prediction of cardiac events following concurrent chemoradiation therapy (CCRT) for non-small-cell lung cancer (NSCLC). We evaluated whether F-18 fluorodeoxyglucose positron emission tomography (FDG PET) early after CCRT, in addition to cardiac dosimetry, could predict late cardiac events in NSCLC. METHODS We retrospectively enrolled 133 consecutive patients with locally advanced, unresectable stage III NSCLC, who underwent FDG PET early after CCRT and survived at least 6 months. The primary endpoint was cardiac event ≥ grade 2 according to the Common Terminology Criteria for Adverse Events (version 5.0). Myocardial FDG uptake was measured and its association with the risk of cardiac events was evaluated. RESULTS FDG PET was performed after a median interval of 11 days of completing CCRT. Overall, 42 (32%) patients experienced cardiac events during a median follow-up of 45 months. The mean heart dose, maximum left ventricular (LV) standardized uptake value (SUV), changes in maximum and mean LV SUV, right ventricular uptake, tumor stage, white blood cell count, and diabetes were associated with cardiac events in univariable analysis. In multivariable analysis, maximum LV SUV (cutoff > 12.84; hazard ratio [95% confidence interval] = 2.140 [1.140-4.016]; p = 0.018) was an independent predictor of cardiac events along with the mean heart dose (> 11.1 Gy; 3.646 [1.792-7.417]; p < 0.001) and tumor stage (IIIB; 1.986 [1.056-3.734]; p = 0.033). It remained predictive of cardiac events in those with higher mean heart dose but not in those with lower mean heart dose. CONCLUSIONS Early FDG PET after CCRT for NSCLC could aid in predicting late cardiac events, especially in patients with higher mean heart dose.
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14
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Increased cardiac uptake of (18F)-fluorodeoxyglucose incidentally detected on positron emission tomography after left breast irradiation: How to interpret? Cancer Radiother 2022; 26:724-729. [DOI: 10.1016/j.canrad.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 12/13/2022]
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15
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Choksey A, Timm KN. Cancer Therapy-Induced Cardiotoxicity-A Metabolic Perspective on Pathogenesis, Diagnosis and Therapy. Int J Mol Sci 2021; 23:441. [PMID: 35008867 PMCID: PMC8745714 DOI: 10.3390/ijms23010441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 12/13/2022] Open
Abstract
Long-term cardiovascular complications of cancer therapy are becoming ever more prevalent due to increased numbers of cancer survivors. Cancer therapy-induced cardiotoxicity (CTIC) is an incompletely understood consequence of various chemotherapies, targeted anti-cancer agents and radiation therapy. It is typically detected clinically by a reduction in cardiac left ventricular ejection fraction, assessed by echocardiography. However, once cardiac functional decline is apparent, this indicates irreversible cardiac damage, highlighting a need for the development of diagnostics which can detect CTIC prior to the onset of functional decline. There is increasing evidence to suggest that pathological alterations to cardiac metabolism play a crucial role in the development of CTIC. This review discusses the metabolic alterations and mechanisms which occur in the development of CTIC, with a focus on doxorubicin, trastuzumab, imatinib, ponatinib, sunitinib and radiotherapy. Potential methods to diagnose and predict CTIC prior to functional cardiac decline in the clinic are evaluated, with a view to both biomarker and imaging-based approaches. Finally, the therapeutic potential of therapies which manipulate cardiac metabolism in the context of adjuvant cardioprotection against CTIC is examined. Together, an integrated view of the role of metabolism in pathogenesis, diagnosis and treatment is presented.
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Affiliation(s)
- Anurag Choksey
- Somerville College, University of Oxford, Woodstock Road, Oxford OX2 6HD, UK;
| | - Kerstin N. Timm
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, UK
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16
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Lang JA, Bhalla S, Ganeshan D, Felder GJ, Itani M. Side Effects of Oncologic Treatment in the Chest: Manifestations at FDG PET/CT. Radiographics 2021; 41:2071-2089. [PMID: 34723703 DOI: 10.1148/rg.2021210130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fluorodeoxyglucose (FDG) PET/CT is a vital imaging technique used for staging, assessing treatment response, and restaging following completion of therapy in patients who are undergoing or have completed oncologic treatment. A variety of adverse effects from chemotherapy, targeted therapy, immunotherapy, and radiation therapy are commonly encountered in oncologic patients. It is important to be aware of the manifestations of these adverse effects seen on FDG PET/CT images to avoid misinterpreting these findings as disease progression. Furthermore, early identification of these complications is important, as it may significantly affect patient management and even lead to a change in treatment strategy. The authors focus on the FDG PET/CT manifestations of a broad spectrum of oncologic therapy-related adverse effects in the thorax, as well as some treatment-related changes that may potentially mimic malignancy. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Jordan A Lang
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Dhakshinamoorthy Ganeshan
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Gabriel J Felder
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
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17
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Eber J, Nannini S, Chambrelant I, Le Fèvre C, Noël G, Antoni D. [Impact of thoracic irradiation on cardiac structures]. Cancer Radiother 2021; 26:526-536. [PMID: 34728116 DOI: 10.1016/j.canrad.2021.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 12/20/2022]
Abstract
Thoracic irradiation requires protection of the heart as an organ at risk of complications. The mean heart dose is the most studied dosimetric parameter in the literature. Recent studies question its relevance in view of the multiplicity of cardiac injuries, the heterogeneity of the cardiac dose distribution and the current technical possibilities to refine cardiac dosimetric protection. The objective of this literature review is to analyze the available scientific data on the impact of the dose received by the cardiac substructures. A search of articles using the PubMed search engine was used to select the most relevant studies. A total of 19 articles were selected according to pre-established criteria to answer the issue. Several studies found significant associations between dosimetric parameters of substructures and clinical cardiological impact. Some proposed dose constraints for substructures.
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Affiliation(s)
- J Eber
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - S Nannini
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - I Chambrelant
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - C Le Fèvre
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - G Noël
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France.
| | - D Antoni
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
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18
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Melo MDTD, Paiva MG, Santos MVC, Rochitte CE, Moreira VDM, Saleh MH, Brandão SCS, Gallafrio CC, Goldwasser D, Gripp EDA, Piveta RB, Silva TO, Santo THCE, Ferreira WP, Salemi VMC, Cauduro SA, Barberato SH, Lopes HMC, Pena JLB, Rached HRS, Miglioranza MH, Pinheiro AC, Vrandecic BALM, Cruz CBBV, Nomura CH, Cerbino FME, Costa IBSDS, Coelho Filho OR, Carneiro ACDC, Burgos UMMC, Fernandes JL, Uellendahl M, Calado EB, Senra T, Assunção BL, Freire CMV, Martins CN, Sawamura KSS, Brito MM, Jardim MFS, Bernardes RJM, Diógenes TC, Vieira LDO, Mesquita CT, Lopes RW, Segundo Neto EMV, Rigo L, Marin VLS, Santos MJ, Grossman GB, Quagliato PC, Alcantara MLD, Teodoro JAR, Albricker ACL, Barros FS, Amaral SID, Porto CLL, Barros MVL, Santos SND, Cantisano AL, Petisco ACGP, Barbosa JEM, Veloso OCG, Spina S, Pignatelli R, Hajjar LA, Kalil Filho R, Lopes MACQ, Vieira MLC, Almeida ALC. Brazilian Position Statement on the Use Of Multimodality Imaging in Cardio-Oncology - 2021. Arq Bras Cardiol 2021; 117:845-909. [PMID: 34709307 PMCID: PMC8528353 DOI: 10.36660/abc.20200266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Mohamed Hassan Saleh
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Daniel Goldwasser
- Hospital Federal de Ipanema, Rio de Janeiro, RJ - Brasil
- Hospital Copa D'Or, Rio de Janeiro, RJ - Brasil
- Casa de Saúde São José, Rio de Janeiro, RJ - Brasil
| | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
| | | | - Tonnison Oliveira Silva
- Hospital Cardio Pulmonar - Centro de Estudos em Cardiologia, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | | | - Vera Maria Cury Salemi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Silvio Henrique Barberato
- CardioEco Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico, Curitiba, PR - Brasil
| | | | | | | | - Marcelo Haertel Miglioranza
- Instituto de Cardiologia do Rio Grande do Sul - Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS - Brasil
- Hospital Mãe de Deus, Porto Alegre, RS - Brasil
| | | | | | | | - César Higa Nomura
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Fernanda Mello Erthal Cerbino
- Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ - Brasil
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Juliano Lara Fernandes
- Radiologia Clínica de Campinas, Campinas, SP - Brasil
- Instituto de Ensino e Pesquisa José Michel Kalaf, Campinas, SP - Brasil
| | - Marly Uellendahl
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Tiago Senra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Bruna Leal Assunção
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- ECOCENTER, Belo Horizonte, MG - Brasil
| | | | - Karen Saori Shiraishi Sawamura
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
- Instituto da Criança da Universidade de São Paulo (USP), São Paulo, SP - Brasil
| | - Márcio Miranda Brito
- Universidade Federal do Tocantins - Campus de Araguaina, Araguaina, TO - Brasil
- Hospital Municipal de Araguaina, Araguaina, TO - Brasil
| | | | | | | | | | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
- Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | - Letícia Rigo
- Hospital Beneficência Portuguesa, São Paulo, SP - Brasil
| | | | | | - Gabriel Blacher Grossman
- Clínica Cardionuclear, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Americas Serviços Médicos, Rio de Janeiro, RJ - Brasil
- Rede D'Or, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Simone Nascimento Dos Santos
- Hospital Brasília - Ecocardiografia, Brasília, DF - Brasil
- Eccos Diagnóstico Cardiovascular Avançado, Brasília, DF - Brasil
| | | | | | | | | | | | - Ricardo Pignatelli
- Texas Children's Hospital, Houston, Texas - EUA
- Baylor College of Medicine, Houston, Texas - EUA
| | - Ludhmilla Abrahão Hajjar
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Roberto Kalil Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Marcelo Antônio Cartaxo Queiroga Lopes
- Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa, PB - Brasil
- Hospital Metropolitano Dom José Maria Pires, João Pessoa, PB - Brasil
- Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - André Luiz Cerqueira Almeida
- Santa Casa de Misericórdia de Feira de Santana - Cardiologia, Feira de Santana, BA - Brasil
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia, São Paulo, SP - Brasil
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19
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Evaluation of the dosimetric impact of heart function-based volumetric modulated arc therapy planning in patients with esophageal cancer. Radiol Phys Technol 2021; 14:279-287. [PMID: 34101136 DOI: 10.1007/s12194-021-00623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Radiotherapy for esophageal cancer entails high-dose irradiation of the myocardium owing to its close anatomical proximity to the esophagus. This study aimed to evaluate the dosimetric impact of functional avoidance planning for the myocardium with volumetric-modulated arc therapy (VMAT) in patients with esophageal cancer and determine the feasibility of functional planning. Ten patients with early stage esophageal cancer were included in this study. The prescribed dose was 60 Gy administered in 30 fractions. An experienced physician contoured the left ventricle (LV) of the myocardium. For each patient, an anatomical plan (non-LV-sparing plan) and a functional plan (LV-sparing plan) were created using the VMAT. In the functional plan, the mean percentage of LV volume receiving a dose of ≥ 30 and ≥ 40 Gy was 6.0% ± 6.7% and 2.4% ± 2.7%, respectively, whereas in the anatomical plan, they were 11.7% ± 13.1% and 4.9% ± 6.5%, respectively. There were no significant differences with respect to the dose to the hottest 1 cm3 of the planning target volume (PTV) and the minimum dose of the gross tumor volume and the dosimetric parameters of other normal tissues between the anatomical and functional plans. We compared the anatomical and functional plans of patients with esophageal cancer undergoing VMAT. Our results demonstrated that the functional plan reduced the dose to the LV with no significant differences in the organs at risk and PTV, indicating that avoidance planning can be safely performed when administering VMAT in patients with esophageal cancer.
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20
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Minamimoto R. Series of myocardial FDG uptake requiring considerations of myocardial abnormalities in FDG-PET/CT. Jpn J Radiol 2021; 39:540-557. [PMID: 33517516 PMCID: PMC8175248 DOI: 10.1007/s11604-021-01097-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/16/2021] [Indexed: 12/18/2022]
Abstract
Distinct from cardiac PET performed with preparation to control physiological FDG uptake in the myocardium, standard FDG-PET/CT performed with 4-6 h of fasting will show variation in myocardial FDG uptake. For this reason, important signs of myocardial and pericardial abnormality revealed by myocardial FDG uptake tend to be overlooked. However, recognition of possible underlying disease will support further patient management to avoid complications due to the disease. This review demonstrates the mechanism of FDG uptake in the myocardium, discusses the factors affecting uptake, and provides notable image findings that may suggest underlying disease.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan.
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21
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Huang YC, Hsu CC, Wu YC, Chen HJ, Chiu NT. Effect of fasting duration on myocardial fluorodeoxyglucose uptake in diabetic and nondiabetic patients. Nucl Med Commun 2021; 42:300-305. [PMID: 33306629 DOI: 10.1097/mnm.0000000000001339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To detect cardiac hypermetabolic lesions using fluorodeoxyglucose (FDG) with PET/computed tomography (PET/CT), the efficiency of long fasting and temperature condition for lowering physiological myocardial FDG uptake is controversial and may be confounded by other factors. We thus aimed to investigate the impact of fasting duration and ambient temperature on myocardial uptake in diabetic and nondiabetic patients. METHODS FDG PET/CT scans (n = 666) were reviewed and the myocardial uptake was visually graded on a four-point scale and quantified using standardized uptake value (SUV). The associations between myocardial uptake and fasting duration, diabetes status, ambient temperature parameters, age, gender, and BMI were evaluated. RESULTS Intraobserver [κ = 0.94; intraclass correlation coefficient (ICC) = 0.99] and interobserver (κ = 0.91; ICC = 0.99) reliabilities of both visual and SUV measurements were all excellent. Fasting duration and diabetes status were found to be significantly associated with myocardial FDG uptake, but the ambient temperature parameters and other factor were not. Patients with intense (Grade 4) myocardial uptake had a shorter fasting duration (P = 0.011). The SUVmax of myocardium was significantly higher in nondiabetic than diabetic patients (P < 0.001). Fasting duration ≥ 12 h in diabetic and ≥16 h in nondiabetic patients was associated with low prevalence of Grade 4 uptake (4.2%, P = 0.016; 2.3%, P = 0.028). CONCLUSION Fasting for long enough durations but not ambient temperature was associated with decreased physiological myocardial FDG uptake. A fasting duration of more than 12 h for diabetic, 16 h for nondiabetic patients is a simple and valuable recommendation.
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Affiliation(s)
- Yung-Cheng Huang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chien-Chin Hsu
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Yi-Chen Wu
- Department of Nuclear Medicine, E-Da Hospital
- Department of Medical Imaging and Radiological Sciences
- Department of Information Engineering, I-Shou University, Kaohsiung
| | - Hong-Jie Chen
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Nan-Tsing Chiu
- Department of Nuclear Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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22
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Umezawa R, Kadoya N, Ota H, Nakajima Y, Saito M, Takagi H, Takanami K, Takahashi N, Ishikawa Y, Yamamoto T, Matsushita H, Takeda K, Takase K, Jingu K. Dose-Dependent Radiation-Induced Myocardial Damage in Esophageal Cancer Treated With Chemoradiotherapy: A Prospective Cardiac Magnetic Resonance Imaging Study. Adv Radiat Oncol 2020; 5:1170-1178. [PMID: 33305078 PMCID: PMC7718544 DOI: 10.1016/j.adro.2020.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The purpose of this prospective study was to evaluate radiation-induced myocardial damage after mediastinal radiation therapy (RT) using late gadolinium-enhancement (LGE) magnetic resonance imaging (MRI). METHODS AND MATERIALS We enrolled 19 patients with esophageal cancer who were expected to have long-term survival by definitive treatment. They underwent delayed contrast-enhanced MRI (19 patients before treatment, 19 patients 6 months after treatment, and 12 patients 1.5 years after treatment). Dose distribution of the left ventricle was made using computed tomography, and the dose volume histogram of the left ventricle was calculated. Myocardial signal intensities in individual MRIs were normalized by the mean values in regions receiving low doses (<5 Gy). Changes in the normalized signal intensities after mediastinal radiation therapy were compared among regions where irradiation doses were 0 to 10 Gy, 10 to 20 Gy, 20 to 30 Gy, 30 to 40 Gy, 40 to 50 Gy, and 50 to 60 Gy, and we investigated whether intensity change was detected in a dose-dependent manner. RESULTS The registered patients were treated with concurrent chemoradiotherapy with a median total dose of 60 Gy (50.4-66 Gy). Chemotherapy consisting of cisplatin and 5-fluorouracil was administered. In the population-based dose-response curve, dose-dependent intensity changes progressively increased in regions receiving more than 30 Gy. The averages of relative intensity change at 6 months and 1.5 years after treatment were 1.1% and -1.9% at 20 to 30 Gy and 37.5% and 17.5% at 40 to 50 Gy, respectively. LGE in regions receiving more than 30 Gy was detected in 68% (13/19) of the patients. CONCLUSIONS A dose-dependent relationship for myocardial signal intensity change was found by using LGE MRI. It may be necessary to reduce the volume of the myocardium receiving more than 30 Gy.
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Affiliation(s)
- Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahide Saito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenobu Takagi
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ken Takeda
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Yan R, Li X, Song J, Guo M, Cai H, Wu Z, Wu P, Li L, Yang M, Wang Y, Li S. Metabolic Changes Precede Radiation-Induced Cardiac Remodeling in Beagles: Using Noninvasive 18F-FDG ( 18F-Fludeoxyglucose) and 13N-Ammonia Positron Emission Tomography/Computed Tomography Scans. J Am Heart Assoc 2020; 9:e016875. [PMID: 32914660 PMCID: PMC7727013 DOI: 10.1161/jaha.120.016875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background This study was performed to characterize the metabolic, functional, and structural cardiac changes in a canine model of radiation‐induced heart disease by serial in vivo imaging and ex vivo analyses. Methods and Results Thirty‐six dogs were randomly assigned to control or irradiated groups at 3 time points (months 3, 6, and 12 after radiation; each group comprised 6 dogs). The left anterior myocardium of dogs in irradiated groups was irradiated locally with a single dose of 20‐Gy X‐ray. The irradiated myocardial regions showed increased myocardial uptake of 18F‐FDG (18F‐fludeoxyglucose) in the irradiated beagles, but the increased uptake area decreased at months 6 and 12 compared with month 3 after radiation. Abnormality of myocardial perfusion and cardiac function were detected at month 6 after radiation. Compared with the control groups, the protein expression of GLUT4 (glucose transporter 4) was upregulated in the irradiated groups, correlating with significantly decreased CPT1 (carnitine acyltransferase 1) expression. Mitochondria degeneration, swelling, and count reduction in the irradiated groups were observed. The difference in CD68 of macrophage markers and the inflammatory cytokines (IL‐6 [interleukin 6], TNF‐α [tumor necrosis factor α]) between the irradiation and control groups was not significant. Furthermore, the progressive aggravation of apoptosis and fibrosis was displayed. Conclusions Elevated 18F‐FDG uptake occurred after irradiation and subsequently led to ventricular perfusion defects and dysfunction. The process was associated with myocardial metabolic substrate remodeling, cardiac muscle cell apoptosis, and myocardial fibrosis rather than inflammation.
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Affiliation(s)
- Rui Yan
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Xiang Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China.,Division of Nuclear Medicine Department of Biomedical Imaging and Image-Guided Therapy Medical University of Vienna Vienna Austria
| | - Jianbo Song
- Department of Radiotherapy Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan China
| | - Min Guo
- Department of Cardiology of First Hospital Shanxi Medical University Taiyuan China
| | - Honghong Cai
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Zhifang Wu
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Ping Wu
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Li Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China
| | - Minfu Yang
- Department of Nuclear Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing China
| | - Yuetao Wang
- Department of Nuclear Medicine The Third Affiliated Hospital of Soochow University The First People's Hospital of Changzhou Changzhou China
| | - Sijin Li
- Department of Nuclear Medicine of First Hospital Shanxi Medical University Taiyuan China.,Province-Ministry Co-construction Cooperative Innovation Center of Precise Diagnosis and Treatment of Molecular Image Taiyuan China
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24
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Sha X, Gong G, Han C, Qiu Q, Yin Y. Quantification of Myocardial Dosimetry and Glucose Metabolism Using a 17-Segment Model of the Left Ventricle in Esophageal Cancer Patients Receiving Radiotherapy. Front Oncol 2020; 10:1599. [PMID: 32850464 PMCID: PMC7431519 DOI: 10.3389/fonc.2020.01599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/23/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Previous studies have shown that increased cardiac uptake of 18F-fluorodeoxyglucose (FDG) on positron emission tomography (PET) may be an indicator of myocardial injury after radiotherapy (RT). The primary objective of this study was to quantify cardiac subvolume dosimetry and 18F-FDG uptake on oncologic PET using a 17-segment model of the left ventricle (LV) and to identify dose limits related to changes in cardiac 18F-FDG uptake after RT. METHODS Twenty-four esophageal cancer (EC) patients who underwent consecutive oncologic 18F-FDG PET/CT scans at baseline and post-RT were enrolled in this study. The radiation dose and the 18F-FDG uptake were quantitatively analyzed based on a 17-segment model. The 18F-FDG uptake and doses to the basal, middle and apical regions, and the changes in the 18F-FDG uptake for different dose ranges were analyzed. RESULTS A heterogeneous dose distribution was observed, and the basal region received a higher median mean dose (18.36 Gy) than the middle and apical regions (5.30 and 2.21 Gy, respectively). Segments 1, 2, 3, and 4 received the highest doses, all of which were greater than 10 Gy. Three patterns were observed for the myocardial 18F-FDG uptake in relation to the radiation dose before and after RT: an increase (5 patients), a decrease (13 patients), and no change (6 patients). In a pairing analysis, the 18F-FDG uptake after RT decreased by 28.93 and 12.12% in the low-dose segments (0-10 Gy and 10-20 Gy, respectively) and increased by 7.24% in the high-dose segments (20-30 Gy). CONCLUSION The RT dose varies substantially within LV segments in patients receiving thoracic EC RT. Increased 18F-FDG uptake in the myocardium after RT was observed for doses above 20 Gy.
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Affiliation(s)
- Xue Sha
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guanzhong Gong
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chunlei Han
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Qingtao Qiu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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25
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Soufer A, Liu C, Henry ML, Baldassarre LA. Nuclear cardiology in the context of multimodality imaging to detect cardiac toxicity from cancer therapeutics: Established and emerging methods. J Nucl Cardiol 2020; 27:1210-1224. [PMID: 30868378 DOI: 10.1007/s12350-019-01671-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 12/21/2022]
Abstract
The complexity of cancer therapies has vastly expanded in the last decade, along with type and severity of cardiac toxicities associated with these treatments. Prevention of pre-clinical cardiotoxicity may improve cardiovascular outcomes and circumvent the decision to place life-sustaining chemotherapeutic agents on hold, making the early detection of cancer therapeutic related cardiac toxicity with non-invasive imaging essential to the care of these patients. There are several established methods of cardiac imaging in the areas of nuclear cardiology, echocardiography, computed tomography, and cardiac magnetic resonance imaging that are used to assess for cardiovascular toxicity of cancer treatments, with several methods under development. The following review will provide an overview of current and emerging imaging techniques in these areas.
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Affiliation(s)
- Aaron Soufer
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Chi Liu
- Department of Radiology and Biomedical Engineering, Yale University School of Medicine, New Haven, CT, USA
| | - Mariana L Henry
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Lauren A Baldassarre
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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Relationship Between Changes in Myocardial F-18 Fluorodeoxyglucose Uptake and Radiation Dose After Adjuvant Three-Dimensional Conformal Radiotherapy in Patients with Breast Cancer. J Clin Med 2020; 9:jcm9030666. [PMID: 32131475 PMCID: PMC7141354 DOI: 10.3390/jcm9030666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 12/28/2022] Open
Abstract
This study aimed to assess the relationship between radiation dose and changes in the irradiated myocardial F-18 fluorodeoxyglucose (FDG) uptake after radiotherapy (RT) in breast cancer patients. The data of 55 patients with left and 48 patients with right breast cancer who underwent curative surgical resection and adjuvant three-dimensional conformal RT and staging (PET1), post-adjuvant chemotherapy (PET2), post-RT (PET3), and surveillance (PET4) FDG positron emission tomography/computed tomography (PET/CT) were retrospectively reviewed. The median interval between PET1 and curative surgical resection, between the end of adjuvant chemotherapy and PET2, between the end of RT and PET3, and between the end of RT and PET4 were five days, 13 days, 132 days, and 353 days, respectively. The myocardial-to-blood pool uptake ratio was measured in all patients. For patients with left breast cancer, the 30 Gy- (30 Gy) and 47.5 Gy-irradiated myocardium-to-low-irradiated myocardium (47.5 Gy) FDG uptake ratios were additionally measured. There were no differences in the myocardial-to-blood pool uptake ratios between left and right breast cancer on all PET scans. For left breast cancer, higher 30 Gy and 47.5 Gy uptake ratios were observed on PET3 than on PET1 and PET2. Both uptake ratios decreased on PET4 compared to PET3, but, were still higher compared to PET1. On PET3 and PET4, the 47.5 Gy were higher than the 30 Gy uptake ratios, while there were no differences between them on PET1 and PET2. Although the whole myocardium FDG uptake showed no significant change, the irradiated myocardium FDG uptake significantly increased after RT and was related to radiation dose to the myocardium in breast cancer patients. These results might be an imaging evidence that supports the increased risk of heart disease after RT in patients with left breast cancer.
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Vinogradskiy Y, Diot Q, Jones B, Castillo R, Castillo E, Kwak J, Bowles D, Grills I, Myziuk N, Guerrero T, Stevens C, Schefter T, Gaspar LE, Kavanagh B, Miften M, Rusthoven C. Evaluating Positron Emission Tomography-Based Functional Imaging Changes in the Heart After Chemo-Radiation for Patients With Lung Cancer. Int J Radiat Oncol Biol Phys 2020; 106:1063-1070. [PMID: 31983558 DOI: 10.1016/j.ijrobp.2019.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Studies have noted a link between radiation dose to the heart and overall survival (OS) for patients with lung cancer treated with chemoradiation. The purpose of this study was to characterize pre- to posttreatment cardiac metabolic changes using fluorodeoxyglucose/positron emission tomography (FDG-PET) images and to evaluate whether changes in cardiac metabolism predict for OS. METHODS AND MATERIALS Thirty-nine patients enrolled in a functional avoidance prospective study who had undergone pre- and postchemoradiation FDG-PET imaging were evaluated. For each patient, the pretreatment and posttreatment PET/CTs were rigidly registered to the planning CT, dose, and structure set. PET-based metabolic dose-response was assessed by comparing pretreatment to posttreatment mean standardized uptake values (SUVmean) in the heart as a function of dose-bin. OS analysis was performed by comparing SUVmean changes for patients who were alive or had died at last follow-up and by using a multivariate model to assess whether pre- to posttreatment SUVmean changes were a predictor of OS. RESULTS The dose-response curve revealed increasing changes in SUV as a function of cardiac dose with an average SUVmean increase of 1.7% per 10 Gy. Patients were followed for a median of 437 days (range, 201-1131 days). SUVmean change was significantly predictive of OS on multivariate analysis with a hazard ratio of 0.541 (95% confidence intervals, 0.312-0.937). Patients alive at follow-up had an average increase of 17.2% in cardiac SUVmean while patients that died had an average decrease in SUVmean decrease of 13.5% (P = .048). CONCLUSIONS Our data demonstrated that posttreatment SUV changes in the heart were significant indicators of dose-response and predictors of OS. The present work is hypothesis generating and must be validated in an independent cohort. If validated, our data show the potential for cardiac metabolic changes to be an early predictor for clinical outcomes.
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Affiliation(s)
- Yevgeniy Vinogradskiy
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Quentin Diot
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Jennifer Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Bowles
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Nicholas Myziuk
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, Missouri
| | - Tracey Schefter
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Laurie E Gaspar
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Chad Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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A case report and review of the literature: cardiotoxicities after radiotherapy for breast cancer patients with high-risk factors of cardiovascular disease. Int Cancer Conf J 2020; 9:41-44. [DOI: 10.1007/s13691-019-00390-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022] Open
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Dreyfuss AD, Jahangiri P, Simone CB, Alavi A. Evolving Role of Novel Quantitative PET Techniques to Detect Radiation-Induced Complications. PET Clin 2019; 15:89-100. [PMID: 31735305 DOI: 10.1016/j.cpet.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiation-induced normal tissue toxicities vary in terms of pathophysiologic determinants and timing of disease development, and they are influenced by the dose and radiation volume the critical organs receive, and the radiosensitivity of normal tissues and their baseline rate of cell turnover. Radiation-induced lung injury is dose limiting for the treatment of lung and thoracic cancers and can lead to fibrosis and potentially fatal pneumonitis. This article focuses on pulmonary and cardiovascular complications of radiation therapy and discusses how PET-based novel quantitative techniques can be used to detect these events earlier than current imaging modalities or clinical presentation allow.
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Affiliation(s)
- Alexandra D Dreyfuss
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Pegah Jahangiri
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, 225 East 126th Street, New York, NY 10035, USA.
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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30
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Radiation-induced myocardial damage indicated by focal defect on 123I-MIBG SPECT. Eur J Nucl Med Mol Imaging 2019; 46:2404-2405. [PMID: 31309257 DOI: 10.1007/s00259-019-04416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
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Heckmann MB, Totakhel B, Finke D, Anker MS, Müller-Tidow C, Haberkorn U, Katus HA, Lehmann LH. Evidence for a cardiac metabolic switch in patients with Hodgkin's lymphoma. ESC Heart Fail 2019; 6:824-829. [PMID: 31278857 PMCID: PMC6676298 DOI: 10.1002/ehf2.12475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/11/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS Our aim was to investigate the glucose uptake in cancer patients suffering from different entities, using 18 F-FDG positron emission tomography-computed tomography scans. We further aimed at identifying potential variables altering cardiac and skeletal muscle glucose metabolism. METHODS AND RESULTS In a retrospective cohort study, we analysed cardiac and skeletal muscle 18 F-FDG uptake in onco-positron emission tomography-computed tomography scans in adult patients suffering from Hodgkin's lymphoma, non-Hodgkin's lymphoma, and non-lymphatic cancer including patients suffering from thyroid cancer, bronchial carcinoma, and malignant melanoma. Univariate logistic regression models were created for increased cardiac and skeletal muscle 18 F-FDG uptake using cancer entity, sex, age, previous radiation, previous chemotherapy, diabetes, obesity, serum glucose levels, renal function, and thyroid function as parameters. Multivariate models were created by selecting variables according to Akaike's information criterion in a step-down approach. Between 2014 and 2018, a total of 337 consecutive patients suffering from Hodgkin's lymphoma (n = 52), non-Hodgkin's lymphoma (n = 57), and non-lymphatic cancer (n = 228) were included in the analysis. Univariate logistic regression models showed high serum glucose levels to be associated with lower absorption rates in both cardiac and skeletal muscle (odds ratio [OR] 0.38 [0.23, 0.60, 95% confidence interval-CI], P < 0.0001, and 0.52 [0.33, 0.82, 95% CI], P < 0.005, respectively). Hodgkin's lymphoma was associated with an increase in cardiac uptake (OR 2.4 [1.3, 4.5, 95% CI], P < 0.005). Decreased skeletal muscle 18 F-FDG uptake was noted in elderly and obese patients. In our multivariate analysis, Hodgkin's lymphoma patients showed higher cardiac 18 F-FDG uptake, while non-Hodgkin's lymphoma patients did not differ significantly from non-lymphatic cancer patients (OR 1.6 [0.7, 3.3, 95% CI], P = 0.24). High serum glucose levels and prior chemotherapy were both associated with a significantly decreased cardiac 18 F-FDG uptake (OR 0.40 [0.24, 0.65, 95% CI], P < 0.0005, and 0.50 [0.27, 0.90, 95% CI], P < 0.05, respectively). Notably, prior chemotherapy did not influence FDG uptake in skeletal muscle to the same extent. Obesity and older age were both significantly associated with decreased gluteal 18 F-FDG uptake (OR 0.49 [0.27, 0.89, 95% CI], P < 0.05, and 0.47 [0.25, 0.87, 95% CI], P < 0.05). CONCLUSIONS Our data provide evidence for metabolic alterations in patients with Hodgkin's lymphoma related to cardiac glucose uptake in humans. This effect was independent from skeletal muscle metabolism.
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Affiliation(s)
- Markus B Heckmann
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Belal Totakhel
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Daniel Finke
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Markus S Anker
- Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology, Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, DKFZ Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Lorenz H Lehmann
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
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Chalubinska-Fendler J, Graczyk L, Piotrowski G, Wyka K, Nowicka Z, Tomasik B, Fijuth J, Kozono D, Fendler W. Lipopolysaccharide-Binding Protein Is an Early Biomarker of Cardiac Function After Radiation Therapy for Breast Cancer. Int J Radiat Oncol Biol Phys 2019; 104:1074-1083. [PMID: 30991100 DOI: 10.1016/j.ijrobp.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/27/2019] [Accepted: 04/07/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the prognostic potential of lipopolysaccharide-binding protein (LBP) levels after breast cancer radiation therapy (RT) for incipient cardiac dysfunction. METHODS AND MATERIALS In this single-centered study, we prospectively enrolled female patients treated for left breast cancer. Healthy age- and sex-matched participants were recruited as controls. LBP levels, cardiac troponin T, N-terminal propeptide of the brain natriuretic peptide, fatty acid binding protein, and C-reactive protein were assessed at three timepoints-before RT, after the last RT fraction, and 1 month after the last fraction. Echocardiographic evaluation was done 3 to 3.75 years after RT. RESULTS We recruited 51 patients and 78 controls. Baseline LBP concentrations in the study group were significantly higher than in controls at baseline (P < .001), at 24 hours, and at 1 month after RT (P = .003 and P < .001, respectively). Other biomarkers (cardiac troponin T, N-terminal propeptide of the brain natriuretic peptide, fatty acid binding protein, and C-reactive protein) did not differ in any of the timepoints. Posttreatment LBP concentrations were significantly and positively correlated with heart- and lung-associated dose-volume histogram variables. Posttreatment and follow-up LBP levels correlated positively with the E/E' echocardiographic index reflective of the diastolic function. After adjustment for left anterior descending artery mean dose, left ventricle mean dose, mean heart dose, and type of surgery, LBP remained significantly correlated with E/E' when measured 24 hours after RT (beta = 0.41, P = .032) and 1 month after RT (beta = 0.43, P = .028). CONCLUSIONS Serum LBP concentrations correlate with diastolic function evaluated 3 years after the completion of RT, making LBP a potentially useful prognostic parameter.
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Affiliation(s)
| | | | - Grzegorz Piotrowski
- Department of Cardiology, N. Copernicus Provincial Multidisciplinary Centre of Oncology and Traumatology, Lodz, Poland; Institute of Health Science, University of Social Science, Lodz, Poland
| | - Krystyna Wyka
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Poland
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland
| | - Bartlomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland; Department of Radiotherapy, Medical University of Lodz, Poland; Postgraduate School of Molecular Medicine, Medical University of Warsaw, Poland
| | - Jacek Fijuth
- Department of Radiotherapy, Medical University of Lodz, Poland
| | - David Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Poland; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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El-Sherif O, Xhaferllari I, Sykes J, Butler J, deKemp RA, Renaud J, Yin H, Wilk B, Sullivan R, Pickering JG, Battista J, Wisenberg G, Prato FS, Gaede S. [ 18F]FDG cardiac PET imaging in a canine model of radiation-induced cardiovascular disease associated with breast cancer radiotherapy. Am J Physiol Heart Circ Physiol 2018; 316:H586-H595. [PMID: 30575441 DOI: 10.1152/ajpheart.00273.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Radiotherapy for the treatment of left-sided breast cancer increases the long-term risk of cardiovascular disease. The purpose of the present study was to noninvasively image the progression of radiation-induced cardiac inflammation in a large animal model using a hybrid PET and MRI system. Five canines were imaged using [18F]fluorodeoxyglucose PET to assess changes in myocardial inflammation. All animals were imaged at baseline, 1 wk, and 1, 3, 6, and 12 mo after focused cardiac external beam irradiation with image guidance. Radiation was delivered in a single fraction. The linear quadratic model was used to convert a typical multifractionated heart dose to a corrected single-fraction biologically equivalent dose. Immunohistochemistry was performed on excised left ventricular tissue samples from all five irradiated canines and one nonirradiated control canine to confirm the presence of inflammation. The mean doses delivered to the entire heart, left ventricle, left anterior descending artery, and left circumflex artery were 1.7 ± 0.2, 2.7 ± 0.2, 5.5 ± 0.9, and 1.1 ± 0.4 Gy, respectively. FDG standard uptake values remained persistently elevated compared with baseline (1.1 ± 0.03 vs. 2.6 ± 0.19, P < 0.05). The presence of myocardial inflammation was confirmed histologically and correlated with myocardial dose. This study suggests a global inflammatory response that is persistent up to 12 mo postirradiation. Inflammation PET imaging should be considered in future clinical studies to monitor the early changes in cardiac function that may play a role in the ultimate development of radiation-induced cardiac toxicity. NEW & NOTEWORTHY Using advanced cardiac PET imaging, we have shown the spatial and quantitative relationship between radiation dose deposition and temporal changes in inflammation. We have shown that the progression of radiation-induced cardiac inflammation is immediate and does not subside for up to 1 yr after radiation. Results are presented in a large animal model that closely resembles the size and vessel architecture of humans. The proposed imaging protocol can be easily replicated for clinical use.
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Affiliation(s)
- Omar El-Sherif
- Department of Medical Biophysics, Western University , London, Ontario , Canada.,Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario , Canada
| | - Ilma Xhaferllari
- Department of Medical Biophysics, Western University , London, Ontario , Canada.,Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario , Canada
| | - Jane Sykes
- Thames Valley Veterinary Services , London, Ontario , Canada.,Lawson Health Research Institute , London, Ontario , Canada
| | - John Butler
- Lawson Health Research Institute , London, Ontario , Canada
| | - Robert A deKemp
- National Cardiac PET Centre, University of Ottawa Heart Institute , Ottawa, Ontario , Canada
| | - Jennifer Renaud
- National Cardiac PET Centre, University of Ottawa Heart Institute , Ottawa, Ontario , Canada
| | - Hao Yin
- Robarts Research Institute, London, Ontario, Canada
| | - Ben Wilk
- Department of Medical Biophysics, Western University , London, Ontario , Canada
| | - Rebecca Sullivan
- Department of Medical Biophysics, Western University , London, Ontario , Canada
| | - J Geoffrey Pickering
- Department of Medical Biophysics, Western University , London, Ontario , Canada.,Lawson Health Research Institute , London, Ontario , Canada.,Robarts Research Institute, London, Ontario, Canada.,Division of Cardiology, London Health Sciences Centre , London, Ontario , Canada
| | - Jerry Battista
- Department of Medical Biophysics, Western University , London, Ontario , Canada.,Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario , Canada
| | - Gerald Wisenberg
- Department of Medical Biophysics, Western University , London, Ontario , Canada.,Lawson Health Research Institute , London, Ontario , Canada.,Division of Cardiology, London Health Sciences Centre , London, Ontario , Canada
| | - Frank S Prato
- Department of Medical Biophysics, Western University , London, Ontario , Canada.,Lawson Health Research Institute , London, Ontario , Canada
| | - Stewart Gaede
- Department of Medical Biophysics, Western University , London, Ontario , Canada.,Department of Physics and Radiation Oncology, London Regional Cancer Program, London, Ontario , Canada.,Lawson Health Research Institute , London, Ontario , Canada
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[18F]fluorodeoxyglucose-positron emission tomography study of genetically confirmed patients with Dravet syndrome. Epilepsy Res 2018; 147:9-14. [DOI: 10.1016/j.eplepsyres.2018.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/24/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022]
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Zhu T, Das S, Wong TZ. Integration of PET/MR Hybrid Imaging into Radiation Therapy Treatment. Magn Reson Imaging Clin N Am 2017; 25:377-430. [PMID: 28390536 DOI: 10.1016/j.mric.2017.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Hybrid PET/MR imaging is in early development for treatment planning. This article briefly reviews research and clinical applications of PET/MR imaging in radiation oncology. With improvements in workflow, more specific tracers, and fast and robust acquisition protocols, PET/MR imaging will play an increasingly important role in better target delineation for treatment planning and have clear advantages in the evaluation of tumor response and in a better understanding of tumor heterogeneity. With advances in treatment delivery and the potential of integrating PET/MR imaging with research on radiomics for radiation oncology, quantitative and physiologic information could lead to more precise and personalized RT.
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Affiliation(s)
- Tong Zhu
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27599, USA
| | - Shiva Das
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27599, USA
| | - Terence Z Wong
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC 27599, USA.
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van den Bogaard VAB, Ta BDP, van der Schaaf A, Bouma AB, Middag AMH, Bantema-Joppe EJ, van Dijk LV, van Dijk-Peters FBJ, Marteijn LAW, de Bock GH, Burgerhof JGM, Gietema JA, Langendijk JA, Maduro JH, Crijns APG. Validation and Modification of a Prediction Model for Acute Cardiac Events in Patients With Breast Cancer Treated With Radiotherapy Based on Three-Dimensional Dose Distributions to Cardiac Substructures. J Clin Oncol 2017; 35:1171-1178. [PMID: 28095159 PMCID: PMC5455600 DOI: 10.1200/jco.2016.69.8480] [Citation(s) in RCA: 308] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose A relationship between mean heart dose (MHD) and acute coronary event (ACE) rate was reported in a study of patients with breast cancer (BC). The main objective of our cohort study was to validate this relationship and investigate if other dose-distribution parameters are better predictors for ACEs than MHD. Patients and Methods The cohort consisted of 910 consecutive female patients with BC treated with radiotherapy (RT) after breast-conserving surgery. The primary end point was cumulative incidence of ACEs within 9 years of follow-up. Both MHD and various dose-distribution parameters of the cardiac substructures were collected from three-dimensional computed tomography planning data. Results The median MHD was 2.37 Gy (range, 0.51 to 15.25 Gy). The median follow-up time was 7.6 years (range, 0.1 to 10.1 years), during which 30 patients experienced an ACE. The cumulative incidence of ACE increased by 16.5% per Gy (95% CI, 0.6 to 35.0; P = .042). Analysis showed that the volume of the left ventricle receiving 5 Gy (LV-V5) was the most important prognostic dose-volume parameter. The most optimal multivariable normal tissue complication probability model for ACEs consisted of LV-V5, age, and weighted ACE risk score per patient (c-statistic, 0.83; 95% CI, 0.75 to 0.91). Conclusion A significant dose-effect relationship was found for ACEs within 9 years after RT. Using MHD, the relative increase per Gy was similar to that reported in the previous study. In addition, LV-V5 seemed to be a better predictor for ACEs than MHD. This study confirms the importance of reducing exposure of the heart to radiation to avoid excess risk of ACEs after radiotherapy for BC.
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Affiliation(s)
| | - Bastiaan D P Ta
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arjen van der Schaaf
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Angelique B Bouma
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Astrid M H Middag
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Enja J Bantema-Joppe
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lisanne V van Dijk
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Femke B J van Dijk-Peters
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Laurens A W Marteijn
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gertruida H de Bock
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Johannes G M Burgerhof
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jourik A Gietema
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Johannes A Langendijk
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - John H Maduro
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anne P G Crijns
- All authors: University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Gharzai L, Verma V, Denniston KA, Bhirud AR, Bennion NR, Lin C. Radiation Therapy and Cardiac Death in Long-Term Survivors of Esophageal Cancer: An Analysis of the Surveillance, Epidemiology, and End Result Database. PLoS One 2016; 11:e0158916. [PMID: 27428362 PMCID: PMC4948887 DOI: 10.1371/journal.pone.0158916] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/23/2016] [Indexed: 12/21/2022] Open
Abstract
Objective Radiation therapy (RT) for esophageal cancer often results in unintended radiation doses delivered to the heart owing to anatomic proximity. Using the Surveillance, Epidemiology, and End Results (SEER) database, we examined late cardiac death in survivors of esophageal cancer that had or had not received RT. Methods 5,630 patients were identified that were diagnosed with esophageal squamous cell carcinoma (SCC) or adenocarcinoma (AC) from 1973–2012, who were followed for at least 5 years after therapy. Examined risk factors for cardiac death included age (≤55/56-65/66-75/>75), gender, race (white/non-white), stage (local/regional/distant), histology (SCC/AC), esophageal location (<18cm/18-24cm/25-32cm/33-40cm from incisors), diagnosis year (1973-1992/1993-2002/2003-2012), and receipt of surgery and/or RT. Time to cardiac death was evaluated using the Kaplan-Meier method. A Cox model was used to evaluate risk factors for cardiac death in propensity score matched data. Results Patients who received RT were younger, diagnosed more recently, had more advanced disease, SCC histology, and no surgery. The RT group had higher risk of cardiac death than the no-RT group (log-rank p<0.0001). The median time to cardiac death in the RT group was 289 months (95% CI, 255–367) and was not reached in the no-RT group. The probability of cardiac death increased with age and decreased with diagnosis year, and this trend was more pronounced in the RT group. Multivariate analysis found RT to be associated with higher probability of cardiac death (OR 1.23, 95% CI 1.03–1.47, HR 1.961, 95% CI 1.466–2.624). Lower esophageal subsite (33–40 cm) was also associated with a higher risk of cardiac death. Other variables were not associated with cardiac death. Conclusions Recognizing the limitations of a SEER analysis including lack of comorbidity accountability, these data should prompt more definitive study as to whether a possible associative effect of RT on cardiac death could potentially be a causative effect.
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Affiliation(s)
- Laila Gharzai
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
- * E-mail:
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Kyle A. Denniston
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Abhijeet R. Bhirud
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Nathan R. Bennion
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America
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Rosa GM, Gigli L, Tagliasacchi MI, Di Iorio C, Carbone F, Nencioni A, Montecucco F, Brunelli C. Update on cardiotoxicity of anti-cancer treatments. Eur J Clin Invest 2016; 46:264-84. [PMID: 26728634 DOI: 10.1111/eci.12589] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/30/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Anti-cancer treatments markedly improved the prognosis of patients, but unfortunately might be hampered by cardiotoxicity. Both symptomatic and asymptomatic clinical forms of heart failure have been reported, which may be reversible or irreversible. The aim of this review is to provide an overview of the antineoplastic agents associated with cardiac toxicity and of the available diagnostic techniques. METHODS AND METHODS This narrative review is based on material from MEDLINE and PUBMED up to November 2015. We looked at the terms antineoplastic drugs and cardiac toxicity in combination with echocardiography, troponins, cardiac magnetic resonance, and positron emission tomography. RESULTS Anthracyclines, monoclonal antibodies, fluoropyrimidines, taxanes, alkylating agents, vinka alkaloids were reported to induce different clinical manifestations of cardioxicity. Chest radiotherapy is also associated with various forms of cardiac damage, which are indistinguishable from those found in patients with heart disease of other aetiologies and that may even appear several years after administration. Among diagnostic techniques, echocardiography is a noninvasive, cost-effective, and widely available imaging tool. Nuclear imaging and cardiac magnetic resonance may be used but are not so widely available and are more difficult to perform. Finally, some biomarkers, such as troponins, may be used to evaluate cardiac damage, but establishing the optimal timing of troponin assessment remains unclear and defining the cut-off point for positivity is still an important goal. CONCLUSIONS Cardiotoxicity of anti-cancer treatments is associated with development of heart failure. Novel diagnostic tools might be relevant to early recognize irreversible forms cardiac diseases.
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Affiliation(s)
- Gian Marco Rosa
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Lorenzo Gigli
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Maria Isabella Tagliasacchi
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Cecilia Di Iorio
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Federico Carbone
- Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, Geneva University, Geneva, Switzerland
| | - Alessio Nencioni
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca Sul Cancro, Genoa, Italy
| | - Fabrizio Montecucco
- Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, Geneva University, Geneva, Switzerland.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Claudio Brunelli
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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Association between radiation dose to the heart and myocardial fatty acid metabolic impairment due to chemoradiation-therapy: Prospective study using I-123 BMIPP SPECT/CT. Radiother Oncol 2016; 119:77-83. [PMID: 26873792 DOI: 10.1016/j.radonc.2016.01.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate long term changes in myocardial fatty acid metabolic impairment caused by chemoradiation-therapy (CRT). MATERIALS AND METHODS We investigated 12 esophageal cancer patients who underwent SPECT/CT using I-123-labeled fatty acid analog (BMIPP) at pre-CRT, pre-boost irradiation, 3-month post-CRT, and 1-year post-CRT. The myocardial uptake was measured using the defect score and the total percentage of uptake (%uptake), which were defined as the sum of the visual scores and that of %uptake in each of 17 segments in the left ventricle (LV), respectively. The correlations between radiation dose to the heart (mean dose, V20, V40, and V60 of the LV and the whole heart (WH)) and the change of myocardial BMIPP uptake from pre-CRT (Δmyocardial BMIPP uptake) were assessed. RESULTS At pre-boost, Δmyocardial BMIPP uptake was significantly correlated with LV-V40 and WH-V60. At 3-month post-CRT, Δmyocardial BMIPP uptake was significantly correlated with LV-V40, WH-V40, and WH-V60. However, there were no statistically significant correlations at 1-year post-CRT. Neither mean dose nor V20 of the LV/WH was significantly correlated with Δmyocardial BMIPP uptake at any time. CONCLUSIONS In the long term after CRT, myocardial metabolism might be affected by factors other than the radiation dose to the heart.
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Haginoya K, Kaneta T, Togashi N, Hino-Fukuyo N, Kobayashi T, Uematsu M, Kitamura T, Inui T, Okubo Y, Takezawa Y, Anzai M, Endo W, Miyake N, Saitsu H, Matsumoto N, Kure S. FDG-PET study of patients with Leigh syndrome. J Neurol Sci 2016; 362:309-13. [PMID: 26944169 DOI: 10.1016/j.jns.2016.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
We conducted a [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) study in five patients (median age 11 (range 4-13) years) with Leigh syndrome to evaluate its usefulness for understanding the functional brain dysfunction in this disease and in future drug trials. Four patients were found to have reported mitochondrial DNA gene mutations. The brain T2-weighted magnetic resonance imaging (MRI) showed high-intensity areas in the putamen bilaterally in five patients, caudate bilaterally in four, thalamus bilaterally in two, and brainstem in one. Cerebellar atrophy was observed in older two patients. For disease control, seven age-matched epilepsy patients who had normal MRI and FDG-PET studies were selected. For semiquantitative analysis of the lesions with decreased (18)F-FDG uptake, the mean standard uptake value (SUV) was calculated in regions of interest (ROIs) placed in each brain structure. We compared the SUV of nine segments (the frontal, temporal, parietal, and occipital lobes, thalami, basal ganglia, mid-brain, pons, and cerebellum) between patients with Leigh syndrome and controls. The glucose uptake was decreased significantly in the cerebellum and basal ganglia, which could explain the ataxia and dystonia in patients with Leigh syndrome. Although this study had some limitations, FDG-PET might be useful for evaluating the brain dysfunction and treatment efficacy of new drugs in patients with Leigh syndrome. Further study with more patients using advanced methods to quantify glucose uptake is needed before drawing a conclusion.
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Affiliation(s)
- Kauzhiro Haginoya
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan; Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai 982-0241, Japan.
| | - Tomohiro Kaneta
- Department of Radiology, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Noriko Togashi
- Department of Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Naomi Hino-Fukuyo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Tomoko Kobayashi
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
| | - Taro Kitamura
- Department of Pediatrics, Sendai City Hospital, Sendai 982-8502, Japan
| | - Takehiko Inui
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai 982-0241, Japan
| | - Yukimune Okubo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan; Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai 982-0241, Japan
| | - Yusuke Takezawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan; Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai 982-0241, Japan
| | - Mai Anzai
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai 982-0241, Japan
| | - Wakaba Endo
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan; Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Sendai 982-0241, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Hirotomo Saitsu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai 980-8574, Japan
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Applications of Fluorodeoxyglucose PET/Computed Tomography in the Assessment and Prediction of Radiation Therapy–related Complications. PET Clin 2015; 10:555-71. [DOI: 10.1016/j.cpet.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Jeraj R, Bradshaw T, Simončič U. Molecular Imaging to Plan Radiotherapy and Evaluate Its Efficacy. J Nucl Med 2015; 56:1752-65. [PMID: 26383148 DOI: 10.2967/jnumed.114.141424] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/08/2015] [Indexed: 12/25/2022] Open
Abstract
Molecular imaging plays a central role in the management of radiation oncology patients. Specific uses of imaging, particularly to plan radiotherapy and assess its efficacy, require an additional level of reproducibility and image quality beyond what is required for diagnostic imaging. Specific requirements include proper patient preparation, adequate technologist training, careful imaging protocol design, reliable scanner technology, reproducible software algorithms, and reliable data analysis methods. As uncertainty in target definition is arguably the greatest challenge facing radiation oncology, the greatest impact that molecular imaging can have may be in the reduction of interobserver variability in target volume delineation and in providing greater conformity between target volume boundaries and true tumor boundaries. Several automatic and semiautomatic contouring methods based on molecular imaging are available but still need sufficient validation to be widely adopted. Biologically conformal radiotherapy (dose painting) based on molecular imaging-assessed tumor heterogeneity is being investigated, but many challenges remain to fully exploring its potential. Molecular imaging also plays increasingly important roles in both early (during treatment) and late (after treatment) response assessment as both a predictive and a prognostic tool. Because of potentially confounding effects of radiation-induced inflammation, treatment response assessment requires careful interpretation. Although molecular imaging is already strongly embedded in radiotherapy, the path to widespread and all-inclusive use is still long. The lack of solid clinical evidence is the main impediment to broader use. Recommendations for practicing physicians are still rather scarce. (18)F-FDG PET/CT remains the main molecular imaging modality in radiation oncology applications. Although other molecular imaging options (e.g., proliferation imaging) are becoming more common, their widespread use is limited by lack of tracer availability and inadequate reimbursement models. With the increasing presence of molecular imaging in radiation oncology, special emphasis should be placed on adequate training of radiation oncology personnel to understand the potential, and particularly the limitations, of quantitative molecular imaging applications. Similarly, radiologists and nuclear medicine specialists should be sensitized to the special need of the radiation oncologist in terms of quantification and reproducibility. Furthermore, strong collaboration between radiation oncology, nuclear medicine/radiology, and medical physics teams is necessary, as optimal and safe use of molecular imaging can be ensured only within appropriate interdisciplinary teams.
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Affiliation(s)
- Robert Jeraj
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; and Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
| | - Tyler Bradshaw
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; and
| | - Urban Simončič
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
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Yan R, Song J, Wu Z, Guo M, Liu J, Li J, Hao X, Li S. Detection of Myocardial Metabolic Abnormalities by 18F-FDG PET/CT and Corresponding Pathological Changes in Beagles with Local Heart Irradiation. Korean J Radiol 2015; 16:919-28. [PMID: 26175594 PMCID: PMC4499559 DOI: 10.3348/kjr.2015.16.4.919] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/24/2015] [Indexed: 01/13/2023] Open
Abstract
Objective To determine the efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the detection of radiation-induced myocardial damage in beagles by comparing two pre-scan preparation protocols as well as to determine the correlation between abnormal myocardial FDG uptake and pathological findings. Materials and Methods The anterior myocardium of 12 beagles received radiotherapy locally with a single X-ray dose of 20 Gy. 18F-FDG cardiac PET/CT was performed at baseline and 3 months after radiation. Twelve beagles underwent two protocols before PET/CT: 12 hours of fasting (12H-F), 12H-F followed by a high-fat diet (F-HFD). Regions of interest were drawn on the irradiation and the non-irradiation fields to obtain their maximal standardized uptake values (SUVmax). Then the ratio of the SUV of the irradiation to the non-irradiation fields (INR) was computed. Histopathological changes were identified by light and electron microscopy. Results Using the 12H-F protocol, the average INRs were 1.18 ± 0.10 and 1.41 ± 0.18 before and after irradiation, respectively (p = 0.021). Using the F-HFD protocol, the average INRs were 0.99 ± 0.15 and 2.54 ± 0.43, respectively (p < 0.001). High FDG uptake in irradiation field was detected in 33.3% (4/12) of 12H-F protocol and 83.3% (10/12) of F-HFD protocol in visual analysis, respectively (p = 0.031). The pathology of the irradiated myocardium showed obvious perivascular fibrosis and changes in mitochondrial vacuoles. Conclusion High FDG uptake in an irradiated field may be related with radiation-induced myocardial damage resulting from microvascular damage and mitochondrial injury. An F-HFD preparation protocol used before obtaining PET/CT can improve the sensitivity of the detection of cardiotoxicity associated with radiotherapy.
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Affiliation(s)
- Rui Yan
- Nursing College of Shanxi Medical University, Taiyuan 030001, China. ; Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Jianbo Song
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Zhifang Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Min Guo
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Jianzhong Liu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Jianguo Li
- Department of Radiological and Environmental Medicine, China Institute for Radiation Protection, Taiyuan 030006, China
| | - Xinzhong Hao
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Sijin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan 030001, China
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Nose H, Otsuka H, Otomi Y, Terazawa K, Takao S, Iwamoto S, Iwase T, Yamada H, Sata M, Harada M. The physiological uptake pattern of (18)F-FDG in the left ventricular myocardium of patients without heart disease. THE JOURNAL OF MEDICAL INVESTIGATION 2015; 61:53-8. [PMID: 24705749 DOI: 10.2152/jmi.61.53] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the physiological uptake pattern of (18)F-FDG in the left ventricular myocardium of patients under preparation for tumor FDG-PET. PATIENTS AND METHODS We enrolled 188 patients without cardiac disease. The accumulation patterns were classified as either 'none', 'diffuse', 'focal' or 'focal on diffuse'. When a focal uptake was only observed on the basal wall, then the patterns were classified as having either a 'ring', 'over half' or 'spot' uptake. RESULTS The frequencies of the myocardial FDG uptake patterns were as follows: none, n=52 (27.7%); diffuse, n=63 (33.5%); focal on diffuse, n=40 (21.3%) and focal, n=33 (17.6%). The age, blood glucose level, weight and dose of FDG did not differ significantly for each pattern. The focal and focal on diffuse patterns were seen in 73 patients, and 65 patients had a focal uptake only on the basal wall; ring uptake in 29 patients, over half in 20 and spot uptake in 16 patients. CONCLUSIONS The physiological myocardial uptake showed several patterns. Focal uptake was often seen in patients with cardiac disease, but it did not always indicate an abnormal finding when the accumulation was only on the basal wall.
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Affiliation(s)
- Hayato Nose
- Department of Radiology, Tokushima University Hospital
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Re: MRI findings of radiation-induced myocardial damage in patients with oesophageal cancer. A reply. Clin Radiol 2015; 70:677-8. [PMID: 25778632 DOI: 10.1016/j.crad.2015.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/28/2015] [Accepted: 02/04/2015] [Indexed: 11/23/2022]
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Geisler BP, Raad RA, Esaian D, Sharon E, Schwartz DR. Apical ballooning and cardiomyopathy in a melanoma patient treated with ipilimumab: a case of takotsubo-like syndrome. J Immunother Cancer 2015; 3:4. [PMID: 25705383 PMCID: PMC4335413 DOI: 10.1186/s40425-015-0048-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 02/03/2015] [Indexed: 11/10/2022] Open
Abstract
Although animal studies have shown that the immunomodulator ipilimumab causes inflammation of the myocardium, clinically significant myocarditis has been observed only infrequently. We report a case of suspected acute coronary syndrome without a culprit lesion on cardiac angiography and takotsubo cardiomyopathy (TC)-like appearance on echocardiography in a patient with metastatic melanoma who received four standard doses of ipilimumab. Apical ballooning, hyperdynamic basal wall motion, systolic anterior motion of the mitral valve, and associated severe left ventricular outflow tract obstruction were present. Restaging with positron emission tomography-computed tomography done soon after discharge incidentally revealed increased fludeoxyglucose uptake in the apex. This case illustrates that a TC-like syndrome might be caused by autoimmune myocarditis after ipilimumab treatment although this was not biopsy-confirmed. Post-marketing surveillance should capture cardiac events occurring in patients treated with ipilimumab to better document and clarify a relationship to the drug, and biopsies should be considered. Physicians utilizing this novel agent should be aware of the potential for immune-related adverse events.
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Affiliation(s)
| | - Roy A Raad
- New York University School of Medicine, New York, NY 10016 USA
| | - Diana Esaian
- New York University School of Medicine, New York, NY 10016 USA
| | - Elad Sharon
- National Cancer Institute, Bethesda, 20892 MD USA
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Beukema JC, van Luijk P, Widder J, Langendijk JA, Muijs CT. Is cardiac toxicity a relevant issue in the radiation treatment of esophageal cancer? Radiother Oncol 2014; 114:85-90. [PMID: 25554226 DOI: 10.1016/j.radonc.2014.11.037] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/04/2014] [Accepted: 11/23/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE In recent years several papers have been published on radiation-induced cardiac toxicity, especially in breast cancer patients. However, in esophageal cancer patients the radiation dose to the heart is usually markedly higher. To determine whether radiation-induced cardiac toxicity is also a relevant issue for this group, we conducted a review of the current literature. METHODS A literature search was performed in Medline for papers concerning cardiac toxicity in esophageal cancer patients treated with radiotherapy with or without chemotherapy. RESULTS The overall crude incidence of symptomatic cardiac toxicity was as high as 10.8%. Toxicities corresponded with several dose-volume parameters of the heart. The most frequently reported complications were pericardial effusion, ischemic heart disease and heart failure. CONCLUSION Cardiac toxicity is a relevant issue in the treatment of esophageal cancer. However, valid Normal Tissue Complication Probability models for esophageal cancer are not available at present.
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Affiliation(s)
- Jannet C Beukema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joachim Widder
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Basu S, Borde C, Kand P. Increasing cardiac 18F-fluorodeoxyglucose (FDG) uptake on PET–CT as a biomarker for cardiotoxicity of chemo-radiotherapy in cancer: A myth or a reality? Radiother Oncol 2014; 112:451-2. [DOI: 10.1016/j.radonc.2014.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/18/2014] [Indexed: 11/29/2022]
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Plitt A, Dorbala S, Albert MA, Giugliano RP. Cardiac sarcoidosis: case report, workup, and review of the literature. Cardiol Ther 2014; 2:181-97. [PMID: 25135396 PMCID: PMC4107425 DOI: 10.1007/s40119-013-0017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cardiovascular disease is the leading cause of death worldwide, with coronary heart disease being the most common manifestation disease. While deaths attributed to coronary heart disease are falling in the developed world, the number of patients with cardiomyopathy continues to increase. In this paper, the current literature on imaging modalities for infiltrative and inflammatory cardiomyopathies is reviewed, focusing on the three most common diagnoses, namely sarcoidosis, amyloidosis, and myocarditis. CASE REPORT A 43-year-old male presented with palpitations and left ventricular systolic dysfunction for a second opinion following an initial nondiagnostic workup. The employed clinical and radiologic approach that led to a definitive diagnosis and disease-specific treatment is presented here. CONCLUSION The current algorithms and the strengths and weaknesses of the various radiologic techniques in establishing a diagnosis in patients who present with new onset cardiomyopathy are reviewed. Recommendations are provided regarding the selection between echocardiography, computed tomography radionuclide imaging, and magnetic resonance imaging in diagnosing the various causes of cardiomyopathy.
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Miyagawa M, Yokoyama R, Nishiyama Y, Ogimoto A, Higaki J, Mochizuki T. Positron emission tomography-computed tomography for imaging of inflammatory cardiovascular diseases. Circ J 2014; 78:1302-10. [PMID: 24817762 DOI: 10.1253/circj.cj-14-0250] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Inflammation is a determinant of atherosclerotic plaque rupture, the event usually responsible for myocardial infarction and stroke. Possible causes of inflammatory cardiomyopathy include myocarditis, eosinophilic disease, and sarcoidosis. Although conventional imaging techniques can identify the site and severity of luminal stenosis, they do not provide information regarding inflammatory status. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for imaging of inflammatory cardiovascular diseases has been rapidly evolving. Integrated PET/computed tomography (CT) is becoming the method of choice for quantification of arterial inflammation across multiple vessels. Moreover, PET/CT provides information about the activation status of inflammatory cells in the vessel wall, thus allowing early diagnosis and risk stratification of patients. The Japanese health insurance system approved reimbursement for FDG-PET use to detect inflammation sites in cardiac sarcoidosis as of April 2012. This approval has necessitated a more detailed assessment of the clinical value of FDG-PET. Standardized preparation, imaging, and image interpretation protocols should be established to sufficiently suppress physiological FDG uptake in the normal myocardium, and thereby facilitate detection of early-stage cardiac inflammatory lesions with more favorable specificity. This review summarizes the background, clinical utility, state-of-the-art advances, and potential future applications of FDG-PET for imaging inflammatory cardiovascular diseases including cardiac sarcoidosis, large-vessel arteritis, and atherosclerosis.
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Affiliation(s)
- Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine
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