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KMID : 1146220190270040268
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Journal of Cardiovascular Imaging
2019 Volume.27 No. 4 p.268 ~ p.279
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Coronary Artery Dose-Volume Parameters Predict Risk of Calcification After Radiation Therapy
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Milgrom Sarah A.
Varghese Bibin
Gladish Gregory W.
Choi Andrew D.
Dong Wenli
Patel Zarana S.
Chung Caroline C.
Rao Arvind
Pinnix Chelsea C.
Gunther Jillian R.
Dabaja Bouthaina S.
Lin Steven H.
Hoffman Karen E.
Huff Janice L.
Slagowski Jordan
Abe Jun-ichi
Iliescu Cezar A.
Banchs Jose
Yusuf Syed Wamique
Lopez-Mattei Juan C.
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Abstract
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BACKGROUND: Radiation exposure increases the risk of coronary artery disease (CAD). We explored the association of CAD with coronary artery dose-volume parameters in patients treated with 3D-planned radiation therapy (RT).
METHODS: Patients who received thoracic RT and were evaluated by cardiac computed tomography ≥ 1 year later were included. Demographic data and cardiac risk factors were retrospectively collected. Dosimetric data (mean heart dose, dmax, dmean, V50 - V5) were collected for the whole heart and for each coronary artery. A coronary artery calcium (CAC) Agatston score was calculated on a per-coronary basis and as a total score. Multivariable generalized linear mixed models were generated. The predicted probabilities were used for receiver operating characteristic analyses.
RESULTS: Twenty patients with a median age of 53 years at the time of RT were included. Nine patients (45%) had ≥ 3/6 conventional cardiac risk factors. Patients received RT for breast cancer (10, 50%), lung cancer (6, 30%), or lymphoma/myeloma (4, 20%) with a median dose of 60 Gy. CAC scans were performed a median of 32 months after RT. CAC score was significantly associated with radiation dose and presence of diabetes. In a multivariable model adjusted for diabetes, segmental coronary artery dosimetric parameters (dmax, dmean, V50, V40 V30, V20, V10, and V5) were significantly associated with CAC score > 0. V50 had the highest area under the ROC curve (0.89, 95% confidence interval, 0.80-0.97).
CONCLUSIONS: Coronary artery radiation exposure is strongly correlated with subsequent segmental CAC score. Coronary calcification may occur soon after RT and in individuals with conventional cardiac risk factors.
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KEYWORD
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Cardio-Oncology, Radiotherapy, Calcium score, Radiation effects, Atherosclerosis
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