A pilot study of (13)N-ammonia cardiac PET imaging to assess subacute cardiotoxicity following adjuvant intensity-modulated radiotherapy for locally advanced breast cancer Journal Article
| Authors: | Nehmeh, S. A.; Fox, J. J.; Schwartz, J.; Ballangrud, Å M.; Schöder, H.; Zhao, Y.; Strauss, H. W.; Yu, A.; Gupta, D.; Powell, S. N.; Ho, A. Y. |
| Article Title: | A pilot study of (13)N-ammonia cardiac PET imaging to assess subacute cardiotoxicity following adjuvant intensity-modulated radiotherapy for locally advanced breast cancer |
| Abstract: | Objective: (1) Assess the feasibility of 13 N-ammonia cardiac PET (13 N-ammonia-PET) imaging in radiotherapy (RT) treatment position in locally-advanced breast cancer (LABC) patients. (2) Correlate pre−/post-RT changes in myocardial flow reserve (MFR) with the corresponding radiation heart dose. Methods: Ten left-sided LABC patients undergoing Volumetric Modulated-Arc-Therapy (VMAT) to chest wall and regional lymph nodes underwent a rest/stress 13 N-ammonia-PET at baseline and (median) 13 months post-RT. Changes in cardiac functions and coronary artery Ca2+ scoring between baseline and follow-up were correlated with average RT dose to the myocardium,3 coronary territories, and 17 myocardial segments. Results: Eight (of 10) patients successfully completed the study. The average rest (stress) global MBF (ml.g-1.min-1) for baseline (follow-up) were 0.83 ± 0.25 (2.4 ± 0.79) and 0.92 ± 0.30 (2.76 ± 0.71), respectively. Differences in MBF, heart rate, blood pressure, and rate-pressure product (RPP) between baseline and follow-up were insignificant (P > 0.1).Strong (R = 0.79; P < 0.01) and moderate (R = 0.53; P = 0.37) correlation existed between MBF Rest and MBF Stress, and RPP respectively. Four patients showed a reduction in MFR of up to ~41% in follow-up studies, increasing to ~52% in myocardial segments close to high-radiation isodose lines in 5/8 patients. Agatston Ca + 2 scoring were zero in both baseline and follow-up in six patients; two patients exhibited mild increase in Ca + 2 on follow-ups (range:10–20).Rest and stress LVEF's were normal (>50) for all patients in both studies. Conclusion: The feasibility of 13 N-ammonia-PET imaging in treatment position of LABC patients was demonstrated. MFR at 1-year post-irradiation of the heart decreased in 50% of the patients. MFR may be a potential index for early detection of cardiotoxicity in BC patients receiving RT to the chest wall. © 2020 |
| Keywords: | follow-up studies; radiotherapy; calcium; intensity-modulated radiotherapy; medical imaging; cardiotoxicity; blood pressure; heart; diseases; volumetric modulated arc therapy; ammonia; cardiac functions; locally advanced breast cancer; coronary arteries; 13n-ammonia pet; cardiac pet imaging; rate-pressure product |
| Journal Title: | Clinical Imaging |
| Volume: | 68 |
| ISSN: | 0899-7071 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2020-12-01 |
| Start Page: | 283 |
| End Page: | 290 |
| Language: | English |
| DOI: | 10.1016/j.clinimag.2020.07.026 |
| PROVIDER: | scopus |
| PUBMED: | 32919154 |
| PMCID: | PMC8207896 |
| DOI/URL: | |
| Notes: | Josef J. Fox's first name is misspelled on the original publication -- Article -- Export Date: 1 October 2020 -- Source: Scopus |
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