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Early cardiac perfusion defects after left-sided radiation therapy for breast cancer: is there a volume response?

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Abstract

Purpose

Cardiac single-photon emission computed tomography (SPECT) is often used to identify defects in myocardial perfusion due to atherosclerotic coronary artery disease. It was also used in studies to evaluate radiation therapy (RT)-associated cardiac abnormalities. In the current review, we aim to evaluate the rates of post-RT cardiac SPECT early perfusion abnormalities and relate this to the irradiated left ventricular volume.

Methods

The studies cited in this systematic review were identified using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Results

Six studies between 1996 and 2016 fulfilled the inclusion criteria. The reported perfusion defects in these studies were seen in the apical and anterolateral aspects of the left ventricle. Three studies show correlation between the percent of the left ventricle within the RT-field and percent of patients with early perfusion defects on cardiac SPECT. In two studies that used cardiac sparing techniques (such as deep inspiration), that resulted in a low mean heart dose, no perfusion defects were noted.

Conclusions

Data suggest that incidental irradiation of the heart in cases of left breast/chest wall RT can result in early post-RT perfusion defects on cardiac SPECT. There appears to be strong dose/volume dependence to the risk, and hence techniques to reduce cardiac exposure are recommended.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA

    Orit Kaidar-Person, Timothy M. Zagar, Jason Matney, Ellen L. Jones, Shiva Das & Lawrence B. Marks

  2. Department of Radiology, University of North Carolina, Chapel Hill, NC, USA

    Jorge Daniel Oldan & Terence Z. Wong

  3. UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA

    Orit Kaidar-Person, Timothy M. Zagar, Jorge Daniel Oldan, Jason Matney, Ellen L. Jones, Shiva Das, Terence Z. Wong & Lawrence B. Marks

  4. Department of Medicine/Division of Cardiology, UNC, Chapel Hill, NC, USA

    Brian C. Jensen

  5. UNC McAllister Heart Institute, Chapel Hill, NC, USA

    Brian C. Jensen

  6. Department of Radiation Oncology, Indiana University, Bloomington, IN, USA

    Richard C. Zellars

Authors
  1. Orit Kaidar-Person
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  2. Timothy M. Zagar
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  3. Jorge Daniel Oldan
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  4. Jason Matney
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  5. Ellen L. Jones
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  6. Shiva Das
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  7. Brian C. Jensen
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  9. Terence Z. Wong
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  10. Lawrence B. Marks
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Corresponding author

Correspondence to Lawrence B. Marks.

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Appendix

Appendix

See Table 6 [39].

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Kaidar-Person, O., Zagar, T.M., Oldan, J.D. et al. Early cardiac perfusion defects after left-sided radiation therapy for breast cancer: is there a volume response?. Breast Cancer Res Treat 164, 253–262 (2017). https://doi.org/10.1007/s10549-017-4248-y

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