Reinders J G, Heijmen B J, Olofsen-van Acht M J, van Putten W L, Levendag P C
Department of Radiation Oncology, Daniel den Hoed Cancer Center/Dijkzigt Hospital, Rotterdam, The Netherlands.
Radiother Oncol. 1999 Apr;51(1):35-42. doi: 10.1016/s0167-8140(99)00026-2.
In patients with Hodgkin's disease treated by radiotherapy with a moderate total dose and a low (mean) fraction dose to the heart, the risk of ischemic heart disease was investigated during long-term follow-up.
The medical records of 258 patients treated in the period 1965-1980 with radiotherapy alone as the primary treatment were reviewed. The median follow-up was 14.2 years (range 0.7-26.2). The mean total dose and fraction dose to the heart were 37.2 Gy (SD 2.9) and 1.64 Gy (SD 0.09), respectively. The impact on the development of ischemic heart disease of treatment-related parameters, such as the applied (fraction) dose, irradiation technique (one or two fields per day), and chemotherapy in case of a relapse, was investigated. The incidence of ischemic heart disease in this patient population was compared with the expected incidence based on gender, age and calendar period-specific data for the Dutch population.
Thirty-one patients (12%) experienced ischemic heart disease (actuarial risk at 20-25 years: 21.2% (95% C.I. 15-30). Twenty-five of them were hospitalized. When compared with the expected incidence, the relative risk (RR) of hospital admission for ischemic heart disease was 2.7 (95% C.I. 1.7-4.0). There were 12 deaths (4.7%) due to ischemic myocardial or sudden death (actuarial risk at 25 years: 10.2% (95% C.I. 5.3-19), compared to 2.3 cases that were expected to have died from these causes, yielding a standardized mortality ratio (SMR) of 5.3 (95% C.I. 2.7-9.3). Gender (male), pretreatment cardiac medical history and increasing age appeared to be the only significant factors for the development of ischemic heart disease.
Despite the moderate total dose and the low (mean) fraction dose to the heart, the observed incidence of ischemic heart disease is high, especially after long follow-up periods. Treatment related cardiac disease in patients treated for Hodgkin's disease has only been reported for doses above 30 Gy. Although the optimum curative dose is still under debate, some studies recommend a dose as low as 32.5 Gy. The observed high rate of severe heart complications in this study advocates a dose reduction to this level, particularly in the regions where the coronary arteries are located.
在接受中等总剂量和低（平均）分次剂量心脏放疗的霍奇金病患者中，对长期随访期间缺血性心脏病的风险进行了研究。
回顾了1965年至1980年期间仅接受放疗作为主要治疗的258例患者的病历。中位随访时间为14.2年（范围0.7 - 26.2年）。心脏的平均总剂量和分次剂量分别为37.2 Gy（标准差2.9）和1.64 Gy（标准差0.09）。研究了治疗相关参数，如应用的（分次）剂量、照射技术（每天一个或两个野）以及复发时的化疗对缺血性心脏病发生的影响。将该患者群体中缺血性心脏病的发病率与基于荷兰人群性别、年龄和特定日历时期数据的预期发病率进行了比较。
31例患者（12%）发生了缺血性心脏病（20 - 25年的精算风险：21.2%（95%置信区间15 - 30））。其中25例住院。与预期发病率相比，因缺血性心脏病住院的相对风险（RR）为2.7（95%置信区间1.7 - 4.0）。有12例（4.7%）死于缺血性心肌梗死或猝死（25年的精算风险：10.2%（95%置信区间5.3 - 19）），而预期因这些原因死亡的病例为2.3例，标准化死亡比（SMR）为5.3（95%置信区间2.7 - 9.3）。性别（男性）、治疗前心脏病史和年龄增长似乎是缺血性心脏病发生的唯一重要因素。
尽管心脏的总剂量中等且（平均）分次剂量较低，但观察到的缺血性心脏病发病率较高，尤其是在长期随访后。仅报道过接受高于30 Gy剂量治疗的霍奇金病患者发生与治疗相关的心脏病。尽管最佳治愈剂量仍在争论中，但一些研究推荐低至32.5 Gy的剂量。本研究中观察到的严重心脏并发症的高发生率主张将剂量降至该水平，特别是在冠状动脉所在区域。
