Poster Presentation Cancer Survivorship 2019

Using Serial cardiac MRI to detect myocardial changes in patients treated with left sided tangential breast radiation (#230)

Simon Tang 1 2 3 , Eng-Siew Koh 1 2 3 , Robba Rai 1 2 3 , James Otton 2 4 , David Tran 4 , Geoff Delaney 1 2 3 , Lois Holloway 1 2 3 5 , Benjamin Schmitt 6 , Gary Liney 1 2
  1. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  2. University of New South Wales, Kensington, NSW, Australia
  3. Liverpool Cancer Therapy Centre, Radiation Oncology, Liverpool, NSW, Australia
  4. Department of Cardiology, Liverpool Hospital, Liverpool, NSW, Australia
  5. University of Sydney, Sydney, NSW, Australia
  6. Siemens Healthcare Pty Ltd, Sydney, NSW, Australia

Purpose

Acute cardiac changes following tangential breast radiation(RT) have been demonstrated using cardiac scintigraphic studies[1, 2] and advanced echocardiographic techniques[3, 4]. This study evaluates the prospective use of serial novel cardiac MRI (CMR) sequences in detecting myocardial changes using serial cardiac mapping techniques over a 12 month period.

Methods

Twenty-one left-sided female breast cancer patients receiving tangential RT were prospectively recruited between October 2015 to October 2016. Three CMR scans were obtained; a baseline scan 2-3 days before adjuvant RT, 6 – 8 weeks and 12 months following RT. No patients received chemotherapy. CMR was performed at 3 tesla using a modified look-locker inversion sequences(T1/T2 mapping) to detect myocardial oedema and inflammation. Extracellular volume (ECV), which may be elevated in oedema, was calculated from pre and post contrast T1 maps[5]. Two independent T1/T2map segmentations of the left ventricle(LV) were performed in cvi42, and averaged for analysis. LV ejection fraction (LVEF) was acquired from single breath-hold SSFP cine acquisitions of the cardiac short axis. Paired t-tests were used to compare the baseline scan with the 6-8 week and 12 month post treatment scans. A p value of ≤0.05 was considered significant. Median mean heart dose(MHD), the average radiation delivered to the heart, was documented.

Results

Median MHD was 2.6Gy(1.5-3.9). There was no change in LVEF at either 6-8 weeks or 12 months post RT. T1 and T2 values were not significantly elevated at 6-8 weeks, but were significantly elevated at 12 months (T1(ms) – 1213 vs 1246ms p=0.02 95% CI 4.4-47.5, T2(ms) – 43.2 vs 45.7ms p<0.01 95% CI 0.8-3.0). There was no change in ECV values.

Conclusions

Preliminary results suggest T1 and T2 values, whilst not significantly different at 6-8 weeks post RT, were elevated 12 months following radiotherapy. These results may be suggestive of post RT myocardial inflammation detected utilising CMR.

 

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