Subclinical left ventricle impairment following breast cancer radiotherapy: Is there an association between segmental doses and segmental strain dysfunction?. (15th December 2021)

• Record Type: Journal Article
• Authors: Fourati, N.; Charfeddine, S.; Chaffai, I.; Dhouib, F.; Farhat, L.; Boukhris, M.; Abid, L.; Kammoun, S.; Mnejja, W.; Daoud, J.
• Is Part Of: International journal of cardiology. Volume 345(2021)
• Page Start: 130
• Page End: 136
• Publication Date: 2021-12-15
• Subjects: Radiotherapy -- Cardiotoxicity -- Echocardiography -- Speckle tracking imaging; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.10.026
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Cardiotoxicity following breast cancer radiotherapy (RT) represents one of the most redoubtable toxicities. The Global longitudinal strain measurement (GLS) based on 2D speckle tracking imaging (STI) allows detection of left ventricular (LV) dysfunction at a subclinical stage. The aim of this prospective study was to detect patients at risk of cardiotoxicity using echocardiographic parameters and to determine the association between segmental RT doses and early cardiac toxicity. Material and methods: The STI was performed prior to RT and at 3, 6 and 12 months after. The association between subclinical LV dysfunction, defined as a reduction of GLS more than 10% from the initial value, radiation doses to different LV segments and non-radiation factors were performed based on multivariate analyses. Results: From June 2017 to August 2018, a total of 103 female patients were included. Sixty patients had left sided RT. Seven patients ( 7.8% ) developed a GSL impairment. The segmental alterations predominated in the anteroseptal and apical LV segments. The mean Dmean in altered segments was significantly higher than in non-altered segments ( 6.7 ± 8.8 Gy -7.8 ± 8.9 Gy vs 4.9 ± 7.9–5.4 ± 8.2Gy ; p < 0.05). Age > 55 years and obesity were important confounding factors that should be considered during radiotherapy planning. Conclusion: The results of our study show that radiation dose is correlated with the subclinical LV segments' alteration. Global heart delineation seems to be insufficient during the breast radiotherapy planning. Segmental delineation of the LV may be an interesting alternative to limit segmental doses and to reduce the risk of subclinical alterations. A mean dose of 5 Gy could be proposed in exposed heart segment. Highlights: Global heart delineation for radiotherapy planning is insufficient. Segmental Left Ventricle delineation is recommended especially for left breast radiotherapy. A-seven segment delineation instead of 17 seems to be sufficient and help to save delineation time. Sub clinical segment alterations detected by longitudinal strain reduction are significantly associated with radiotherapy doses in univariate and multivariate analysis. A limit of 5Gy in left ventricle segments may be used during radiotherapy planning.