Background: Cardiotoxicity remains a concern across cancer therapies. To date, there is a lack of extensive studies evaluating the potential impact of radioligand therapy (RLT) on myocardial injury in patients with neuroendocrine tumors (NETs), particularly in subgroups with increased susceptibility to such injury. This study aimed to assess the potential cardiotoxic effects and myocardial dysfunction associated with RLT using both [177Lu]Lu-DOTA-TATE and tandem therapy with [177Lu]Lu-DOTA-TATE/[90Y]Y-DOTA-TATE in patients with NETs, including specific high-risk subgroups such as patients with pre-existing heart failure, carcinoid heart disease or those previously treated with chemotherapy, by monitoring serum concentration of troponin I, CK-MB, and NT-proBNP before and after RLT.Methods: We conducted a retrospective observational analysis of 60 consecutive NET patients who underwent 228 RLT courses. A comprehensive cardiac assessment, including a detailed medical history, was performed. Additionally, serum troponin I, CKMB and NT-proBNP concentrations were measured prior to treatment and 48 h post-therapy. Fifty-two patients received [177Lu]Lu-DOTA-TATE monotherapy, while eight patients were treated with tandem therapy.Results: No increase in cardiotoxicity markers was observed in the overall study population following RLT administration (ΔTroponin −0.2 [−1.4–0.3]ng/L,p= 0.007; ∆CKMB 0.0 [−4.0–3.0]U/L,p= 0.90; ΔNT-proBNP 4.0 [−45.6–33.6]pg/mL) as well as in the subgroup receiving tandem therapy (ΔTroponin 0.7 [−1.7–013]ng/L,p= 0.68; ΔCKMB −0.5 [−10.7–3.0]U/L,p= 0.21; ΔNT-proBNP −21.6 [−44.1–16.7]pg/mL). Furthermore, none of the predefined patient subgroups exhibited signs of cardiotoxicity or evidence of myocardial dysfunction.Conclusions: RLT is a safe anticancer treatment option for patients with NETs in terms of cardiotoxicity and cardiac dysfunction, including those at higher risk of cardiovascular complications.
背景：心脏毒性仍是各类癌症治疗中备受关注的问题。目前，尚缺乏广泛研究评估放射性配体疗法（RLT）对神经内分泌肿瘤（NET）患者心肌损伤的潜在影响，特别是在对此类损伤易感性增加的亚组中。本研究旨在通过监测RLT前后血清肌钙蛋白I、CK-MB和NT-proBNP浓度，评估NET患者（包括特定高风险亚组，如既往存在心力衰竭、类癌心脏病或既往接受过化疗的患者）使用[177Lu]Lu-DOTA-TATE单药治疗及[177Lu]Lu-DOTA-TATE/[90Y]Y-DOTA-TATE联合疗法可能产生的心脏毒性效应和心肌功能障碍。 方法：我们对连续接受228个RLT疗程的60例NET患者进行了回顾性观察分析。进行了全面的心脏评估，包括详细的病史采集。此外，在治疗前和治疗后48小时测量了血清肌钙蛋白I、CK-MB和NT-proBNP浓度。52例患者接受了[177Lu]Lu-DOTA-TATE单药治疗，8例患者接受了联合疗法。 结果：在总体研究人群中，RLT给药后未观察到心脏毒性标志物升高（Δ肌钙蛋白 −0.2 [−1.4–0.3] ng/L, p=0.007；ΔCKMB 0.0 [−4.0–3.0] U/L, p=0.90；ΔNT-proBNP 4.0 [−45.6–33.6] pg/mL），在接受联合疗法的亚组中同样未观察到升高（Δ肌钙蛋白 0.7 [−1.7–0.13] ng/L, p=0.68；ΔCKMB −0.5 [−10.7–3.0] U/L, p=0.21；ΔNT-proBNP −21.6 [−44.1–16.7] pg/mL）。此外，所有预设的患者亚组均未显示心脏毒性迹象或心肌功能障碍证据。 结论：就心脏毒性和心脏功能障碍而言，RLT是NET患者（包括心血管并发症风险较高的患者）一种安全的抗癌治疗选择。
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