Prosnitz Robert G, Chen Yu Husuan, Marks Lawrence B
Department of Radiation Oncology, Duke University, Box 3085 Duke University Medical Center, Durham, NC 27710, USA.
Semin Oncol. 2005 Apr;32(2 Suppl 3):S71-80. doi: 10.1053/j.seminoncol.2005.03.013.
While the data regarding radiotherapy (RT)-induced cardiovascular disease in lung cancer patients is limited, the cardiotoxic effects of RT have been thoroughly documented in long-term survivors of breast cancer and Hodgkin's disease. Herein we review data illustrating the cardiotoxic effects of thoracic RT in lung and breast cancer patients. Older RT techniques for treating the breast/chest wall and draining lymph nodes resulted in a relatively high dose being delivered to a substantial volume of heart, and convincing evidence exists of excess cardiovascular morbidity and mortality in patients treated with these techniques. While modern RT techniques have reduced radiation exposure to the heart, they have not eliminated it. In patients treated with modern techniques, there are conflicting data regarding the impact of radiation on late cardiovascular morbidity and mortality. Thus, it is prudent to reduce cardiac exposure as much as possible. Techniques to reduce further cardiac exposure (eg, respiratory gating, intensity modulated radiation therapy) are currently under investigation. Further work is needed to quantify the frequency and severity of cardiac injury and develop preventative methods.
虽然关于肺癌患者放疗（RT）诱发心血管疾病的数据有限，但RT的心脏毒性作用在乳腺癌和霍奇金病的长期幸存者中已有详尽记录。在此，我们回顾说明胸部RT对肺癌和乳腺癌患者心脏毒性作用的数据。用于治疗乳房/胸壁及引流淋巴结的较老的RT技术导致相当大体积的心脏接受相对高剂量照射，并且有令人信服的证据表明接受这些技术治疗的患者心血管发病率和死亡率过高。虽然现代RT技术已减少了对心脏的辐射暴露，但并未消除这种暴露。在接受现代技术治疗的患者中，关于辐射对晚期心血管发病率和死亡率的影响的数据存在矛盾。因此，尽可能减少心脏暴露是审慎的做法。目前正在研究进一步减少心脏暴露的技术（如呼吸门控、调强放射治疗）。需要进一步开展工作以量化心脏损伤的频率和严重程度并开发预防方法。
