Chang Albert S Y, Smedira Nicholas G, Chang Catherine L, Benavides Monica M, Myhre Ulf, Feng Jingyuan, Blackstone Eugene H, Lytle Bruce W
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Thorac Cardiovasc Surg. 2007 Feb;133(2):404-13. doi: 10.1016/j.jtcvs.2006.09.041. Epub 2007 Jan 8.
Mediastinal radiation for thoracic malignancies uses multiple treatment fields and doses. We investigated whether more extensive radiation exposure is associated with more hospital complications and worse survival after cardiac surgery.
From January 2000 to January 2005, 230 patients underwent cardiac surgery after 3 levels of mediastinal radiation: extensive (Hodgkin disease, thymoma, and testicular cancer; n = 70), variable (eg, non-Hodgkin lymphoma and lung cancer; n = 35); and tangential (breast cancer; n = 125). Hospital complications were recorded prospectively, and time-related survival was assessed by patient follow-up (mean follow-up, 2.2 +/- 1.4 years).
Patients receiving extensive exposure were youngest (51 vs 64 vs 72 years), with the longest radiation-to-operation interval (25 vs 13 vs 14 years), and had the most diastolic dysfunction, left main stenosis of greater than 70% (21% vs 9% vs 8%), and aortic regurgitation (79% vs 54% vs 50%). Patients receiving extensive and variable exposure had the poorest pulmonary function (percent predicted forced expiratory volume in 1 second, 57% vs 54% vs 67%; percent predicted forced vital capacity, 56% vs 63% vs 66%). All groups received a similar mix of cardiac procedures. Hospital deaths (13% vs 8.6% vs 2.4%) and respiratory complications (24% vs 20% vs 9.6%) were higher after more extensive radiation, and survival was poorer (4-year survival, 64% vs 57% vs 80%) than for patients receiving tangential radiation exposure, and it deviated more from expected matched-population life tables.
Among patients undergoing cardiac surgery after thoracic radiation, radiation exposure is heterogeneous, and therefore these patients cannot be managed and assessed as a single uniform cohort. Extensively irradiated patients are more likely to develop radiation heart disease, which increases perioperative morbidity and decreases short- and long-term survival.
胸部恶性肿瘤的纵隔放疗采用多个治疗野和剂量。我们研究了更广泛的辐射暴露是否与心脏手术后更多的医院并发症和更差的生存率相关。
从2000年1月至2005年1月，230例患者在接受3种水平的纵隔放疗后接受了心脏手术：广泛放疗（霍奇金病、胸腺瘤和睾丸癌；n = 70）、可变放疗（如非霍奇金淋巴瘤和肺癌；n = 35）；以及切线放疗（乳腺癌；n = 125）。前瞻性记录医院并发症，并通过患者随访评估与时间相关的生存率（平均随访时间，2.2 +/- 1.4年）。
接受广泛暴露的患者最年轻（51岁对64岁对72岁），放疗至手术间隔最长（25年对13年对14年），舒张功能障碍最多，左主干狭窄大于70%（21%对9%对8%），以及主动脉反流（79%对54%对50%）。接受广泛和可变暴露的患者肺功能最差（预计1秒用力呼气量百分比，57%对54%对67%；预计用力肺活量百分比，56%对63%对66%）。所有组接受的心脏手术组合相似。更广泛放疗后医院死亡率（13%对8.6%对2.4%）和呼吸并发症（24%对20%对9.6%）更高，生存率比接受切线放疗的患者更差（4年生存率，64%对57%对80%），并且与预期的匹配人群生命表偏差更大。
在胸部放疗后接受心脏手术的患者中，辐射暴露是异质性的，因此这些患者不能作为一个单一的统一队列进行管理和评估。接受广泛放疗的患者更有可能发生放射性心脏病，这会增加围手术期发病率并降低短期和长期生存率。
