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Communication Dans Un Congrès Année : 2019

Cardiotoxicity after breast cancer radiotherapy: relationship between cardiac doses and early myocardial dysfunction (BACCARAT study)

Olivier Lairez
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  • PersonId : 930117
Olivier Fondard
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  • PersonId : 1064115
Atul Pathak
Gaëlle Jimenez
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  • PersonId : 1064117
Jeremy Camilleri
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Jean Ferrieres
  • Fonction : Auteur
  • PersonId : 1064118

Résumé

Background: Breast cancer (BC) radiotherapy (RT) can be associated with long-term cardiotoxicity. Use of longitudinal strain (LS) as a sensitive parameter of left ventricular myocardial dysfunction has been suggested. Aim: To analyze the relationship between cardiac exposure and LS changes post-RT in BC patients. Methods: This is a monocentric prospective cohort study that included left or right unilateral BC patients treated with RT without chemotherapy between 2015 and 2017. Each patient was included just before RT and is followed for 2 years with cardiac imaging examinations, including strain echocardiography for the detection of subclinical left ventricular dysfunction with measurement of global LS (GLS). Individual dosimetric evaluation provided information on cardiac doses in particular for whole heart and left ventricle (LV) and coronary arteries. The event "decreased GLS" was defined as ≥10% reduction from baseline. Results: This analysis was based on 94 patients (76 left-sided BC), aged 58±8 years with a follow-up of 6 months post-RT. Mean doses to the heart and LV were respectively: 3.0, and 6.7 Gy for the left-sided patients; 0.6, and 0.2 Gy for the right-sided patients. An altered GLS was observed for left-sided BC patients (-15.5±3.7% before RT vs. -14.1±4.0% at RT+6 months, p=0.02). Considering cardiac doses for the whole population, both mean dose to the heart and LV were significantly associated with "decreased GLS": OR/1Gy=1.4 95% CI [1.1 – 1.9] (p=0.02) and OR/1Gy=1.2 [1.1 – 1.3] (p=0.01) respectively. LV dose was the best predictor of "decreased GLS", in particular the volume of LV in %, receiving at least 10 Gy (OR/1%=1.07 [1.02 – 1.12], p=0.007). Conclusion: This study is the first to establish a dose-response relationship between RT-induced cardiac doses and decreased GLS, 6 months post-RT, illustrating the potential importance to reduce cardiac exposure in order to limit the risk of LV dysfunction.
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hal-03210298 , version 1 (11-03-2022)

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  • HAL Id : hal-03210298 , version 1

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Valentin Walker, Olivier Lairez, Olivier Fondard, Atul Pathak, Christain Chevelle, et al.. Cardiotoxicity after breast cancer radiotherapy: relationship between cardiac doses and early myocardial dysfunction (BACCARAT study). 16th International Congress of Radiation Research (ICRR 2019), Aug 2019, MANCHESTER, United Kingdom. ⟨hal-03210298⟩
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