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Abstract
Our group has demonstrated that tangential radiation therapy (RT) to the left breast
or chest wall can cause perfusion changes in the anterior myocardium. We assess if
RT-induced perfusion changes are associated with the development of symptoms consistent
with cardiac dysfunction. Between 1998 and 2001, 114 patients were enrolled into an
institutional review board—approved prospective study and had pre-RT and serial post-RT
(range, 6-24 months) single photon emission computed tomography (SPECT) scans to assess
changes in regional cardiac perfusion. Thirty-one patients were excluded. The incidence
of cardiac symptoms in patients with and without RT-induced perfusion defects was
compared using a 2-tailed Fisher's exact test. With a median follow-up of 16 months
(range, 6-24 months), 10 of 83 evaluable patients had ≥ 1 episode of transient chest
pain, occurring 0-14 months after RT (median, 6 months). The rates of chest pain in
the patients with and without new perfusion defects were 9 of 31 and 1 of 52, respectively
(P = 0.0004). A similar result was found when patients were segregated based on the
use of chemotherapy. Two of these 10 cases were diagnosed as pericarditis. No patient
had myocardial infarction or congestive heart failure. Cardiac symptoms occur more
frequently in patients with perfusion abnormalities by SPECT after RT than in patients
with normal SPECT scans, suggesting that such perfusion defects may be clinically
significant. One confounding factor is that women who know they have RT-induced perfusion
defects may be more likely to report episode of chest pain. Long-term follow-up will
be necessary to better assess the clinical significance of RT-induced perfusion defects.
Key words
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Article info
Publication history
Accepted:
June 16,
2003
Received in revised form:
June 2,
2003
Received:
April 4,
2003
Identification
Copyright
© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
