乳腺癌患者胸壁放疗后心肌灌注改变及影响因素

目的探讨乳腺癌患者胸壁放射治疗方式、蒽环类药物累积剂量、血脂等因素与心肌灌注改变的相关性。方法选择接受含蒽环类抗癌药方案化疗后的有放疗指征的乳腺癌病人52例,分别于放疗前和放疗后6个月行99mTc-MIBI心肌灌注显像;采用Logistic逐步回归进行多因素分析,探讨胸壁不同照射方式、不同照射部位(左侧胸壁和右侧胸壁)、蒽环类药物累积剂量、血脂等因素对心肌灌注改变的影响。结果本研究52例病人接受放疗前心肌灌注均示正常,而接受放疗后6个月共有18例出现心肌灌注改变,占34.6%(18/52),所有患者均无心脏损伤的临床症状;放射治疗照射方式及部位与心肌灌注改变的发生无显著相关性;病人年龄、紫杉醇、三苯氧胺等因素与心肌灌注改变的发生亦无显著相关性;但蒽环类抗癌药物累积剂量(p=0.020,OR:1.010,95%CI:1.002~1.018)和血脂增高(p=0.028,OR:4.529,95%CI:1.173~11.485)与心肌灌注改变的发生呈正相关。结论乳腺癌根治术后采用6MeV电子束照射胸壁或保乳术后采用6MV光子线切线野照射乳腺/胸壁,对心肌灌注改变的影响均较小。接受含蒽环类抗癌药方案化疗的乳腺癌患者,其心肌灌注改变与蒽环类药物累积剂量呈正相关。高血脂是乳腺癌患者综合治疗后心肌灌注改变发生的危险因素之一。

MYOCARDIAL PERFUSION CHANGES AND RELATED FACTORS IN BREAST CANCER PATIENTS AFTER CHEST-WALL IRRADIATION

Objective To investigate the correlation between the myocardial perfusion changes and modalities of chest-wall irradiation, accumulated dose of anthracycline, hypercholesterolemia in breast cancer patients. Methods Fifty-two patients with breast cancer treated with anthracycline-containing chemotherapy underwent myocardial perfusion imaging using 99 mTc-MIBI single photon emission computed tomography(SPECT) pre-radiotherapy and 6 months post-radiotherapy. Logistic test was used to analyze the correlation between the myocardial perfusion changes and modalities (electron/photon) and location (left/right) of chest-wall irradiation, accumulated dose of anthracycline, paclitaxel, tamoxifen, hypercholesterolemia and age. Results There were eighteen patients(34.6%) had new perfusin defects 6 months post-radiotherapy. In logistic multivariate analysis, the perfusion defects were independently associated with the accumulated dose of anthracycline(p=0.02,OR:1.010,95%CI:1.002~1.018) and pre-radiotherapy hypercholesterolemia (p=0.028,OR:4.529,95%CI:1.173~11.485).The perfusion defects were not statistically associated with modalities and location of chest-wall irradiation, paclitaxel, tamoxifen and age. Conclusion The modality of radiotherapy used in our study had little influence on myocardial perfusion defects of breast cancer patient post-breast/chest wall irradiation. Risk factors related to the perfusion defects included the high accumulated dose of anthracycline and hypercholesterolemia.