Mediastinal Adipose Tissue as a Biomarker and Predictor of Anthracycline Cardiotoxicity in Adolescents and Young Adults

AYA with new sarcoma diagnoses and treated with high cumulative anthracycline doxorubicin (dox) dose 300-450 mg/m2 were included in the present study for prospective evaluation. Eligibility criteria included routine CT scans available prior to the start of treatment and after completion of therapy. Mediastinal adipose tissue area and density (quantified via HU, indicative of fat composition or quality) was quantified via routine computed tomography scans at the level of thoracic vertebrae 4 (T4) at 3 time points; baseline (prior to chemotherapy), post-chemotherapy (immediately after primary Dox completion), and 1 year follow-up since baseline. Images were anonymized, manually segmented, and analyzed with a web toolkit for analytic morphomics, CoreSlicer. MAT area was normalized to participant height. MAT was identified using a threshold set for −50 to −250 Hounsfield units (HU).Cardiac function outcomes were quantified with routine echocardiography at baseline and 1 year. Image interpretation was performed prospectively by a single cardiologist following standard definitions published by the American Society of Echocardiography. The purpose of the present study was to determine the relationship between MAT and cardiac function in adolescents and young adults (AYA) with cancer who received cardiotoxic anthracycline chemotherapy treatment.