Abstract 12238: Is Myocardial F-!8 Flurodeoxyglucose Uptake on PET-CT Predictive of Cardiac Toxicity Following Radiation Treatment?
Background: Myocardial imaging with FDG-PET, in the fasting state is used to image inflammatory diseases such as sarcoidosis. A proposed pathophysiology for cardiac complications following chest radiotherapy (XRT) includes inflammation and a relationship between post-XRT myocardial FDG uptake and cardiac complications has been reported. We studied the incidence of cardiac complications post-XRT in patients with lung or esophageal cancer and examined possible predictors including radiation dosimetry and changes in myocardial FDG uptake after XRT.
Methods: We retrospectively identified patients with lung or esophageal cancer who received chest XRT and had pre-XRT and post-XRT FDG-PET scan. Myocardial FDG uptake in the lateral wall and interventricular septum was quantified as maximum standardized uptake value (mSUV) units. Change in mSUV was designated as >1 or <1. Post-XRT cardiac events were identified by chart review. Radiation dose was quantified and the extent of radiation volume was identified as the Planning Target Volume (PTV).
Results: A total of 82 patients (68.3 ± 12.8 years; 54% male; 76% lung cancer) formed the study group. Mean follow-up was 722± 588 days. An increase in mSUV >1 was noted in 50% of patients between pre-XRT and post-XRT PET albeit, not statistically significant (p=0.12). The incidence of complications post- XRT was as follows: Congestive heart failure 7.3%; LV systolic dysfunction 11%; myocardial infarction 1.2%; arrhythmia 23.2%, pericardial effusion 15.9%; typical angina chest pain 2.4%; and non-anginal chest pain 13.4%. Pre-XRT, post-XRT or change in FDG uptake was not a predictor of cardiac complications. However extent of radiation defined by PTV correlated with the number of cardiac complications (Spearman’s rho=0.31, p=0.01). Radiation dose or FDG uptake and standard clinical variables such as hypertension, age and coronary artery disease were not predictive of the most common complication which was atrial arrhythmias (23%).
Conclusions: Cardiac complications occur in a quarter of patients following XRT for treatment of lung or esophageal cancer and correlates with extent of radiation (PTV) but not with change in myocardial FDG uptake or radiation dose. These findings require further study in large population.
Author Disclosures: N.H. Aldweib: None. G. Pasricha: None. V. Kudithipudi: None. M. Trombetta: None. D. Monga: None. I. Poornima: None.
- © 2014 by American Heart Association, Inc.