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Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3):656-65. doi: 10.1016/j.ijrobp.2009.09.064.
The heart has traditionally been considered a radio-resistant organ that would be unaffected by cardiac doses below about 30 Gray. During the last few years, however, evidence that radiation-related heart disease can occur following lower doses has emerged from several sources. These include studies of breast cancer patients, who received mean cardiac doses of 3–17 Gray when given radiotherapy following surgery, and studies of survivors of the atomic bombings of Japan who received doses of up to 4 Gray. At doses above 30 Gray, radiation-related heart disease may occur within a year or two of exposure and risk increases with higher radiotherapy dose, younger age at irradiation, and the presence of conventional risk factors. At lower doses the typical latent period is much longer and is often more than a decade. However, the nature and magnitude of the risk following lower doses is not well characterized, and it is not yet clear whether there is a threshold dose below which there is no risk. The evidence regarding radiation-related heart disease comes from several different disciplines. The present review brings together information from pathology, radiobiology, cardiology, radiation oncology and epidemiology. It summarises current knowledge, identifies gaps in that knowledge, and outlines some potential strategies for filling them. Further knowledge about the nature and magnitude of radiation-related heart disease would have immediate application in radiation oncology. It would also provide a basis for radiation protection policies for use in diagnostic radiology and occupational exposure.
传统上认为心脏是一种对辐射具有抗性的器官，在接受约 30 戈瑞以下的心脏剂量时不会受到影响。然而，在过去的几年中，已经有来自多个来源的证据表明，心脏剂量较低时也可能发生与辐射相关的心脏病。这些证据包括接受了手术切除后的放射治疗的乳腺癌患者的研究，这些患者的心脏平均接受剂量为 3-17 戈瑞；还包括接受了 4 戈瑞以内剂量的日本原子弹爆炸幸存者的研究。在 30 戈瑞以上的剂量下，与辐射相关的心脏病可能在暴露后的一到两年内发生，并且随着放射治疗剂量的增加、照射时的年龄越小以及存在传统的风险因素，风险也会增加。在较低的剂量下，典型的潜伏期要长得多，通常超过十年。然而，对于较低剂量下的风险的性质和程度还没有很好的描述，也不清楚是否存在低于该剂量就没有风险的阈值剂量。与辐射相关的心脏病的证据来自多个不同的学科。本综述汇集了来自病理学、放射生物学、心脏病学、放射肿瘤学和流行病学的信息。它总结了当前的知识，确定了知识中的空白，并概述了一些填补这些空白的潜在策略。关于与辐射相关的心脏病的性质和程度的进一步了解将立即应用于放射肿瘤学。它还将为诊断放射学和职业暴露中的辐射防护政策提供基础。
