Domercant Jean, Polin Nichole, Jahangir Eiman
Department of Internal Medicine, Leonard J. Chabert Medical Center, Houma, LA.
Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Ochsner J. 2016 Fall;16(3):250-6.
Cardio-oncology is a collaborative approach between cardiologists and oncologists in the treatment of patients with cancer and heart disease. Radiation and chemotherapy have played a major role in the decreased cancer-related mortality achieved in the past 2 decades. However, anthracycline-, tyrosine kinase-, and radiation-based therapies are each associated with independent cardiovascular (CV) risks, and these risks are cumulative when these therapies are used in combination.
We analyzed several published articles, studies, and guidelines to provide a focused review of cardiotoxicity associated with anthracyclines, human epidermal growth factor receptor 2 inhibitors, and radiation therapy and its management.
The focus on CV risk among individuals being treated with cardiotoxic agents is important because once the cancer is cured, CV disease becomes the number 1 cause of death among cancer survivors. Cardio-oncology focuses on assessing CV risk prior to starting therapy, optimizing modifiable risk factors, and providing surveillance and treatment for any early signs of cardiotoxicity in patients undergoing radiation and chemotherapy. A collaborative approach between oncologists and cardiologists is integral to the optimal care of patients with cancer. Although radiation and chemotherapy treatments have evolved with the aim of targeting cancer cells while having minimal effect on the heart, the increased risk of cardiomyopathy in patients receiving these treatments remains significant.
Proper screening and treatment of cardiotoxicity are essential for patients with cancer. As cardiac diseases and cancer remain the first and second causes of mortality in developed nations, respectively, cardio-oncology is the answer to this group of individuals who are especially vulnerable to both causes of mortality.
心脏肿瘤学是心脏病专家和肿瘤学家在治疗癌症和心脏病患者时采用的一种协作方法。放疗和化疗在过去20年实现的癌症相关死亡率下降中发挥了主要作用。然而，基于蒽环类药物、酪氨酸激酶和放疗的治疗方法各自都存在独立的心血管（CV）风险，当这些治疗方法联合使用时，这些风险会累积。
我们分析了几篇已发表的文章、研究和指南，以重点综述与蒽环类药物、人表皮生长因子受体2抑制剂、放疗及其管理相关的心脏毒性。
关注接受心脏毒性药物治疗的个体的心血管风险很重要，因为一旦癌症治愈，心血管疾病就会成为癌症幸存者的首要死因。心脏肿瘤学专注于在开始治疗前评估心血管风险，优化可改变的风险因素，并对接受放疗和化疗的患者出现的任何心脏毒性早期迹象进行监测和治疗。肿瘤学家和心脏病专家之间的协作方法对于癌症患者的最佳护理至关重要。尽管放疗和化疗治疗方法的发展目标是靶向癌细胞同时对心脏影响最小，但接受这些治疗的患者发生心肌病的风险增加仍然很大。
对癌症患者进行心脏毒性的适当筛查和治疗至关重要。由于心脏病和癌症分别仍然是发达国家的第一和第二大死因，心脏肿瘤学是解决这一特别易受两种死因影响的人群问题的答案。
