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. 2015 Apr 21:10:96.
doi: 10.1186/s13014-015-0410-z.

Assessment of myocardial metabolic disorder associated with mediastinal radiotherapy for esophageal cancer -a pilot study

Rei Umezawa  1 , Kentaro Takanami  2 , Noriyuki Kadoya  3 , Yujiro Nakajima  4 , Masahide Saito  5 , Hideki Ota  6 , Haruo Matsushita  7 , Toshiyuki Sugawara  8 , Masaki Kubozono  9 , Takaya Yamamoto  10 , Yojiro Ishikawa  11 , Ken Takeda  12 , Yasuyuki Taki  13 , Kei Takase  14 , Keiichi Jingu  15
Affiliations

Assessment of myocardial metabolic disorder associated with mediastinal radiotherapy for esophageal cancer -a pilot study

Rei Umezawa et al. Radiat Oncol. .

Abstract

Background: To evaluate the dose-effect relations for myocardial metabolic disorders after mediastinal radiotherapy (RT) by performing iodine-123 β-methyl-iodophenyl pentadecanoic acid (I-123 BMIPP) scintigraphy.

Methods: Between 2011 and 2012, we performed I-123 BMIPP scintigraphy for patients with esophageal cancer before and six months after curative mediastinal RT. Single photon emission computed tomography (SPECT) images of pre-RT and post-RT were registered into RT dose distributions. The myocardium was contoured, and the regional RT dose was calculated. Normalization is required to compare pre- and post-RT SPECT images because the uptake pattern is changed due to the breathing level. Normalization was applied on the mean of SPECT counts in regions of the myocardium receiving less than 5 Gy. Relative values in each dose region (interval of 5 Gy) were calculated on the basis of this normalization for each patient. The reduction in the percent of relative values was calculated.

Results: Five patients were enrolled in this study. None of the patients had a past history of cardiac disease. The left ventricle was partially involved in RT fields in all patients. The patients received RT with median total doses of 60-66 Gy for the primary tumor and metastatic lymph nodes. Concomitant chemotherapy consisting of cisplatin or nedaplatin and 5-fluorouracil with RT was performed in 4 patients. All patients had reduced uptake corresponding to RT fields. Dose-effect relations for reduced uptake tended to be observed at 6 months after RT with mean decreases of 8.96% in regions at 10-15 Gy, 12.6% in regions at 20-25 Gy, 15.6% in regions at 30-35 Gy, 19.0% in regions at 40-45 Gy and 16.0% in regions at 50-55 Gy.

Conclusions: Dose-effect relations for myocardial metabolic disorders tended to be observed. We may need to make an effort to reduce high-dose mediastinal RT to the myocardium in RT planning.

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Figures

Figure 1
Figure 1
Evaluation of the relations between radiation dose and myocardial metabolic disorder. Normalization was applied on the mean of single photon emission computed tomography counts in regions of the myocardium receiving less than 5 Gy (red arrow). Relative values in each dose region (interval of 5 Gy) were calculated on the basis of this normalization for each patient. The reduction in the percent of relative values was calculated.
Figure 2
Figure 2
Dose volume histograms of the myocardium for 5 patients.
Figure 3
Figure 3
Results of dose-effect relations for myocardial metabolic disorder. Dose-effect relations for reduced uptake tended to be observed.
Figure 4
Figure 4
Findings of single photon emission computed tomography (SPECT) in Case 5. Reduced uptake corresponding to anterior-posterior fields was observed (red arrow). (a) pre-RT SPECT. (b) post-RT SPECT.
See this image and copyright information in PMC

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