Mège A, Ziouèche A, Pourel N, Chauvet B
Radiothérapie, institut Sainte-Catherine, 1750, chemin du Lavarin, 84000 Avignon, France.
Cancer Radiother. 2011 Oct;15(6-7):495-503. doi: 10.1016/j.canrad.2011.06.003. Epub 2011 Aug 31.
The radiotherapy of thoracic cancers exposes the heart to late radiation-induced complications. The physiopathological and clinical consequences of heart irradiation have been mostly studied in patients with Hodgkin lymphoma and breast cancer. The main cause of cardiac morbidity is radiation-induced coronaropathy with a relative risk estimated between 2 and 3 in earlier studies. Preexisting factors of cardiovascular risk, including chemotherapy, potentalize the cardiotoxicity of radiotherapy. Conformational radiotherapy, adapting the ballistics and the energy to the delineated volumes while carefully evaluating the dose-volume distribution in the organs at risk, allowed a drastic reduction in cardiac mortality. This toxicity no longer seems to be significant if the cardiac volume has received less than 30 Gy. Nevertheless, the prolonged life expectancy of cancer patients and the expanding use of new cardiotoxic anticancer drugs underline the persistent need to further reduce the dose delivered to the heart. Indeed, 1 Gy added to the mean heart dose would increase the cardiotoxic risk by 4% (IC 95%: 2-6%, P=0.0002). A strengthened collaboration between the radiation oncologist and the cardiologist aims at detecting and treating long-term complications after thoracic radiotherapy.
胸段癌症的放射治疗会使心脏面临迟发性辐射诱导的并发症。心脏照射的生理病理和临床后果大多在霍奇金淋巴瘤和乳腺癌患者中进行了研究。心脏发病的主要原因是辐射诱导的冠状动脉疾病，早期研究估计其相对风险在2至3之间。包括化疗在内的心血管风险的既有因素会增强放射治疗的心脏毒性。适形放射治疗，在仔细评估危及器官的剂量体积分布的同时，使弹道和能量适应所勾画的体积，可大幅降低心脏死亡率。如果心脏体积接受的辐射剂量低于30 Gy，这种毒性似乎不再显著。然而，癌症患者预期寿命的延长以及新型心脏毒性抗癌药物的广泛使用凸显了进一步降低心脏所接受剂量的持续需求。确实，平均心脏剂量每增加1 Gy，心脏毒性风险会增加4%（95%置信区间：2 - 6%，P = 0.0002）。放射肿瘤学家和心脏病学家之间加强合作旨在检测和治疗胸段放射治疗后的长期并发症。
