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The analysis of correlation between changes of myocardial enzymes level in serum before and after radiation and dose-volume histogram parameters of the heart
DING Xiu-ping*, LI Hong-jun, LI Bao-sheng, WANG Dong-qing
*Department of Radiation Oncology, Shandong Cancer Hospital& Institute;Shandong Provincial Key Laboratory of Radiation Oncology;Shandong Academy of Medical Sciences;Jinan 250117, China Corresponding author:LI Bao-sheng, Email:baoshli@yahoo.com
Abstract Objective To analyze the correlation between the changes of myocardial enzyme level inserum before and after radiotherapy and dose-volume histogram (DVH) parameters of the heart. Methods A total of 102 patients with 68 cases of lung cancer and 34 cases of esophageal cancer were recruited. All patients received three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT), with the radiation beams passing through the heart. Aspertate aminotransferase (AST), creatine kinase (CK), creatine kinase isozyme (CK-MB), lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH) were determined in the serum before and after radiotherapy. All the enzyme levels before and after radiotherapy were compared through paired t-test. Independent sample t-test was conducted between sub-groups. And the dose-volume histogram (DVH) parameters of the heart were calculated (the volume percentage of heart receiving dose equal to or exceeding x Gy (Vx). The correlation between myocardial enzyme level and DVH parameters was analyzed through Pearson method. Results Serum AST, CK-MB, LDH, α-HBDH levels increased significantly after radiotherapy (19.42∶27.89,14.72∶19.57,178.80∶217.57,140.32∶176.25,t=－3.39－－6.92,all P=0.000). In Group IMRT, significant correlations between the increase of myocardial enzyme concentration and DVH parameters of the heart are found, AST with V20, V25, V30 of heart (r=0.302－0.431,P=0.039－0.003), CK with V30 of heart (r=0.345,P=0.013),and CK-MB, LDH, α-HBDH with V25, V30(r=0.465－0.376,P=0.001－0.005). In Group CRT, there are significant correlations between changes of CK-MB, LDH level and V30of heart (r=0.330,0.274,P=0.014,0.033), α-HBDH and V25, V30, and V35 of heart (r=0.270－0.331,P=0.046－0.014). When the irradiation dose was more than 50 Gy, significant correlations were found between the concentration changes of AST, LDH, α-HBDH and V25, V30 of heart (r=0.256－0.359,P=0.019－0.006), CK-MB and V30(r=0.233,P=0.037). When the irradiation dose was 50 Gy or less, only the concentration change of serum CK has significant correlation with V5 and V45 of heart (r=0.581,0.536,P=0.023,0.043). Conclusions There exists certain correlations between changes of myocardial enzymes level before and after radiation and DVH parameters of the heart, which indicates that the DVH parameters of heart are helpful to evaluate the radiation-induced myocardial damage.
DING Xiu-ping*,LI Hong-jun,LI Bao-sheng et al. The analysis of correlation between changes of myocardial enzymes level in serum before and after radiation and dose-volume histogram parameters of the heart[J]. Chinese Journal of Radiation Oncology, 2012, 21(3): 227-230.
DING Xiu-ping*,LI Hong-jun,LI Bao-sheng et al. The analysis of correlation between changes of myocardial enzymes level in serum before and after radiation and dose-volume histogram parameters of the heart[J]. Chinese Journal of Radiation Oncology, 2012, 21(3): 227-230.
[1] Boivin JF, Hutchison GB, Lubin JH, et al. Coronary artery disease mortality in patients treated for Hodgkin′s disease. Cancer,1992,69:1241-1247. [2] Gaya AM, Ashford RF. Cardiac complications of radiation therapy. Clin Oncol,2005,17:153-159. [3] Zambetti M, Moliterni A, Materazzo C, et al. Long-term cardiac sequelae in operable breast cancer patients given adjuvant chemotherapy with or without doxorubicin and breast irradiation. J Clin Oncol,2001,19:37-43. [4] Hardenbergh PH, Munley MT, Bentel GC, et al. Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin:preliminary results. Int J Radiat Oncol Biol Phys,2001,49:1023-1028. [5] Vallis KA, pintilie M, Chong N, et al. Assessment of coronary heart disease morbidity and mortality after radiation therapy for early breast cancer. J Clin Oncol,2002,20:1036-1042. [6] Muren LP, Maurstad, Hafslund R, et al. Cardiac and pulmonary doses and complication probabiolities in standard and conformal tangential irradiation in conservstive management of breast cancer. Radiother Oncol,2002,62:173-183. [7] 许臣洪,李欣,黄伟荧. 血清心肌钙蛋白Ⅰ诊断心脏放射性损伤的研究. 中华放射医学与防护杂志,1999,19:393-394. [8] Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Onco1 Bio1 Phys,1991,21:109-122. [9] Krayenbuehl J, Oertel S, Davis JB, et al. Combined photon and electron three-dimensional conformal versus intensity-modulated radiotherapy with integrated boost for adjuvant treatment of malignant pleural mesothelioma after pleuropneumonectomy. Int J Radiat Oncol Biol Phys,2007,69:1593-1599. [10] Lagrange JL, Darcourt J, Benoliel J, et al. Acute cardiac effects of mediastinal irradiation:assessment by radionuclide angiography. Int J Radiat Oncol Biol Phys,1992,22:897-903. [11] 李光,赵晶,李蓉,等.胸部肿瘤病人放疗中血清心肌酶学的变化.中国医科大学学报,1999,28:213-214. [12] El-Awady, El-SE, Moustafa YM, et al. Cisplatin-induced cardiotoxicity:mechanisms and cardioprotective strategies. Eur J Pharmacol,2011,650:335-341.
2012, Vol. 21 
