Friedlander Arthur H, Sung Eric C, Child John S
VA Greater Los Angeles Healthcare System, Calif. 90073, USA.
J Am Dent Assoc. 2003 Dec;134(12):1615-20. doi: 10.14219/jada.archive.2003.0108.
People with Hodgkin's disease and breast cancer often receive therapeutic irradiation to the chest (mediastinum) as an element of treatment. While the therapy often cures the malignancy, it has been implicated in causing late-onset heart disease that may influence the provision of dental treatment.
The authors conducted a MEDLINE search of the years 1995 through 2002 using the key terms "Hodgkin's disease," "breast cancer," "radiation therapy," "cardiac valves" and "coronary artery" to define the pathophysiology of the disorder, its epidemiology and dental implications. The articles they selected for further review included those published in English in peer-reviewed journals.
Therapeutic irradiation of the chest results in the inadvertent inclusion of the heart within the irradiation field. Over the next 10 to 20 years, some of these people may experience pathological changes of the heart valves that could predispose them to endocarditis, accelerated atherosclerosis of the coronary artery that heightens their risk of experiencing a fatal myocardial infarction or both.
Dentists need to identify patients who have received therapeutic irradiation to the chest and consult with the patients' physicians to determine whether the therapy has damaged the heart valves or coronary arteries. Patients with radiation-induced valvular disease may require prophylactic antibiotics when undergoing specific dental procedures that are known to cause a bacteremia and a heightened risk of developing endocarditis. Patients with radiation-induced coronary artery disease should be administered only limited amounts of local anesthetic agents containing a vasoconstrictor, and they may require the administration of sedative agents and cardiac medications to preclude ischemic episodes.
霍奇金淋巴瘤和乳腺癌患者在治疗过程中常接受胸部（纵隔）的放射治疗。虽然这种治疗通常能治愈恶性肿瘤，但它被认为会引发迟发性心脏病，这可能会影响牙科治疗的实施。
作者使用关键词“霍奇金淋巴瘤”“乳腺癌”“放射治疗”“心脏瓣膜”和“冠状动脉”对1995年至2002年期间的医学文献数据库进行检索，以明确该疾病的病理生理学、流行病学及牙科相关影响。他们挑选出来进一步综述的文章包括在同行评审期刊上发表的英文文章。
胸部放射治疗会导致心脏意外地被纳入照射野。在接下来的10至20年里，其中一些人可能会出现心脏瓣膜的病理变化，这可能使他们易患心内膜炎、冠状动脉加速动脉粥样硬化，从而增加致命性心肌梗死的风险，或两者皆有。
牙医需要识别曾接受胸部放射治疗的患者，并与患者的医生协商，以确定该治疗是否损害了心脏瓣膜或冠状动脉。患有放射诱导性瓣膜病的患者在接受已知会导致菌血症和心内膜炎发生风险增加的特定牙科手术时，可能需要预防性使用抗生素。患有放射诱导性冠状动脉疾病的患者应仅使用限量的含血管收缩剂的局部麻醉剂，并且他们可能需要使用镇静剂和心脏药物以预防缺血发作。
