Gagliardi G, Lax I, Rutqvist L E
Department of Hospital Physics, Radiumhemmet, Karolinska Hospital, 171 76 Stockholm, Sweden.
Semin Radiat Oncol. 2001 Jul;11(3):224-33. doi: 10.1053/srao.2001.23483.
Radiation-induced heart disease (RIHD) includes pericarditis, ischemic heart disease, and myocardial infarction and leads in some cases to fatal complications. It has been shown that the increased survival due to radiotherapy could be negated by excess deaths from RIHD in breast cancer radiotherapy for left-sided tumors. Subclinical effects following irradiation have been detected in several studies both of breast cancer and Hodgkin's irradiation. The dose-volume response relationships describing cardiac complications have been studied for pericarditis and cardiac mortality by means of biologic models, including the well-known Lyman-Kutcher-Burman (LKB) model and Källman's relative seriality model. Studies by Martel and coworkers on pericarditis and by Gagliardi and coworkers on cardiac mortality are reviewed. The anatomical and functional definition of the heart represents a key issue in modeling, as it affects strongly the dosimetrical data to be used as input data in the models. Several treatment strategies to decrease heart irradiation, based on models and/or based on dose-distribution evaluations, are reviewed. It is concluded that left-sided breast cancer patients should always be 3-dimensional (3D) dose planned.
放射性心脏病（RIHD）包括心包炎、缺血性心脏病和心肌梗死，在某些情况下会导致致命并发症。研究表明，在左侧肿瘤的乳腺癌放疗中，RIHD导致的额外死亡可能会抵消因放疗而提高的生存率。在多项乳腺癌和霍奇金淋巴瘤放疗研究中均检测到了照射后的亚临床效应。通过生物模型，包括著名的莱曼-库彻-伯曼（LKB）模型和卡尔曼相对序列性模型，研究了描述心脏并发症的心包炎和心脏死亡率的剂量-体积反应关系。回顾了马特尔及其同事关于心包炎的研究以及加利亚尔迪及其同事关于心脏死亡率的研究。心脏的解剖学和功能定义是建模中的一个关键问题，因为它强烈影响用作模型输入数据的剂量学数据。综述了基于模型和/或基于剂量分布评估的几种减少心脏照射的治疗策略。得出的结论是，左侧乳腺癌患者应始终进行三维（3D）剂量规划。
