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Radiation-induced cardiac damage in early left breast cancer patients: risk factors, biological mechanisms, radiobiology, and dosimetric constraints.早期左侧乳腺癌患者的放射性心脏损伤：危险因素、生物学机制、放射生物学和剂量学限制。
Radiother Oncol. 2012 May;103(2):133-42. doi: 10.1016/j.radonc.2012.02.008. Epub 2012 Mar 3.
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A review of the clinical evidence for intensity-modulated radiotherapy.调强放疗的临床证据回顾。
Clin Oncol (R Coll Radiol). 2010 Oct;22(8):643-57. doi: 10.1016/j.clon.2010.06.013. Epub 2010 Jul 31.
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Survey of the availability and use of advanced radiotherapy technology in the UK.英国先进放疗技术的供应和使用情况调查。
Clin Oncol (R Coll Radiol). 2010 Oct;22(8):636-42. doi: 10.1016/j.clon.2010.06.014. Epub 2010 Jul 27.
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Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry.俯卧位与仰卧位在全乳和部分乳腺放疗中的应用：非靶区组织剂量学比较。
Radiother Oncol. 2010 Aug;96(2):178-84. doi: 10.1016/j.radonc.2010.05.014. Epub 2010 Jun 17.
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The lateral decubitus breast boost: description, rationale, and efficacy.侧卧位乳房提升术：描述、原理和疗效。
Int J Radiat Oncol Biol Phys. 2010 Jan 1;76(1):100-3. doi: 10.1016/j.ijrobp.2009.01.053.
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Radiation-induced cardiac toxicity after therapy for breast cancer: interaction between treatment era and follow-up duration.乳腺癌治疗后放射性心脏毒性：治疗时代与随访时间之间的相互作用
Int J Radiat Oncol Biol Phys. 2009 Mar 15;73(4):980-7. doi: 10.1016/j.ijrobp.2008.11.016.
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Estimating cardiac exposure from breast cancer radiotherapy in clinical practice.在临床实践中估算乳腺癌放疗所致的心脏受照剂量。
Int J Radiat Oncol Biol Phys. 2009 Mar 15;73(4):1061-8. doi: 10.1016/j.ijrobp.2008.05.066. Epub 2008 Oct 28.
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Potential effect of robust and simple IMRT approach for left-sided breast cancer on cardiac mortality.稳健且简单的左侧乳腺癌调强放射治疗方法对心脏死亡率的潜在影响。
Int J Radiat Oncol Biol Phys. 2009 May 1;74(1):73-80. doi: 10.1016/j.ijrobp.2008.07.018. Epub 2008 Oct 28.
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Cardiac toxicity in breast cancer survivors: review of potential cardiac problems.乳腺癌幸存者的心脏毒性：潜在心脏问题综述
Clin Cancer Res. 2008 Jan 1;14(1):14-24. doi: 10.1158/1078-0432.CCR-07-1033.
10
Clinical relevance of pulmonary toxicity in adjuvant breast cancer irradiation.辅助性乳腺癌放疗中肺毒性的临床相关性。
Acta Oncol. 2006;45(1):13-5. doi: 10.1080/02841860500466632.

左侧乳腺癌放疗中心脏意外受照。

Unintended cardiac irradiation during left-sided breast cancer radiotherapy.

机构信息

Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, UK.

出版信息

Br J Radiol. 2013 Feb;86(1022):20120434. doi: 10.1259/bjr.20120434.

DOI:10.1259/bjr.20120434
PMID:23385997
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3608042/
Abstract

OBJECTIVE

Cardiac irradiation during left-sided breast radiotherapy may lead to deleterious cardiac side effects. Using image guided radiotherapy, it is possible to exclude the heart from treatment fields and monitor reproducibility of virtual simulation (VS) fields at treatment delivery using electronic portal imaging (EPI). Retrospectively, we evaluate the incidence of cardiac irradiation at VS and subsequent unintended cardiac irradiation during treatment.

METHODS

Patients receiving left-sided radiotherapy to the breast or chest wall, treated with a glancing photon field technique during a four-month period, were included. VS images and EPIs during radiotherapy delivery were visually assessed. The presence of any portion of the heart within the treatment field at VS or during treatment was recorded. Central lung distance and maximum heart distance were recorded.

RESULTS

Of 128 patients, 45 (35.1%) had any portion of the heart within the planned treatment field. Of these, inclusion of the heart was clinically unavoidable in 25 (55.6%). Of those with no heart included in the treatment fields at VS, 41 (49.4%) had presence of the heart as assessed on EPI during treatment.

CONCLUSION

Unintended cardiac irradiation during left-sided breast radiotherapy treatment occurs in a sizeable proportion of patients.

ADVANCES IN KNOWLEDGE

Despite the use of three-dimensional computed tomography simulation and cardiac shielding, sizeable proportions of patients receiving left-sided breast cancer radiotherapy have unintended cardiac irradiation.

摘要

目的

左侧乳腺癌放疗过程中心脏受到照射可能导致有害的心脏副作用。使用图像引导放疗，可以将心脏排除在治疗野之外，并在治疗时使用电子射野影像装置（EPI）监测虚拟模拟（VS）野的可重复性。我们回顾性评估 VS 时心脏受照以及随后治疗期间非预期心脏受照的发生率。

方法

纳入在四个月期间接受左侧乳房或胸壁放疗且采用掠入射光子技术治疗的患者。对放疗过程中的 VS 图像和 EPI 进行视觉评估。记录 VS 或治疗期间治疗野内任何部分心脏的存在情况。记录中央肺距离和最大心脏距离。

结果

128 例患者中，45 例（35.1%）的心脏的任何部分位于计划治疗野内。其中，25 例（55.6%）因临床需要将心脏包含在治疗野内。在 VS 时未将心脏纳入治疗野的患者中，41 例（49.4%）在治疗期间 EPI 评估时发现存在心脏。

结论

左侧乳腺癌放疗治疗过程中，相当一部分患者会出现非预期的心脏照射。

知识进展

尽管使用了三维计算机断层扫描模拟和心脏屏蔽，但相当一部分接受左侧乳腺癌放疗的患者会出现非预期的心脏照射。