Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Clin Breast Cancer. 2018 Oct;18(5):e819-e824. doi: 10.1016/j.clbc.2018.05.010. Epub 2018 Jun 14.
Radiotherapy (RT) for breast cancer improves survival, but poses risk to the heart, resulting from a linear relationship between RT dose and heart disease. This review presents studies worldwide reporting heart doses from whole breast RT after 2014 to update a previous systematic review (Taylor et al, Int J Radiat Oncol Biol Phys, 2015) in order to determine patterns of current heart dosimetry among varying RT regimens. Studies published between January 2014 and September 2017 were included if they reported whole heart dose based on whole breast RT technique or treatment position and had a sample size of ≥ 20 patients. Studies reporting brachytherapy, proton RT only, or boost to tumor bed were excluded. Among 99 studies, whole heart dose was reported by 231 regimens. The mean heart dose for left-sided breast cancer, reported by 84 studies (196 regimens), was 3.6 Gy, compared with a review of those previously reported (5.4 Gy). Regimens employing breathing control in any position had a significantly lower mean heart dose (1.7 Gy) compared with regimens without breathing control (4.5 Gy) (P < .0001). The mean heart dose varied significantly between continents (P < .0001), with heterogeneity reported among countries within Europe (P = .04) although not within other continents. On average, the mean heart dose steadily decreased between 2014 (4.6 Gy) and 2017 (2.6 Gy) (P = .003). Other heart dose parameters including the mean dose to the left anterior descending artery were reported by 80 left-sided regimens, and the mean left anterior descending artery dose was 12.4 Gy.
放射治疗（RT）可改善乳腺癌患者的生存率，但也会增加心脏病风险，这是因为 RT 剂量与心脏病之间存在线性关系。本综述介绍了 2014 年后全球报道的全乳 RT 后心脏剂量的研究，以更新之前的系统综述（Taylor 等人，Int J Radiat Oncol Biol Phys，2015 年），从而确定不同 RT 方案中心脏剂量学的当前模式。如果研究报告了基于全乳 RT 技术或治疗体位的全心脏剂量，且样本量≥20 例，则纳入 2014 年 1 月至 2017 年 9 月期间发表的研究。排除仅报告近距离放疗、质子 RT 或肿瘤床加量的研究。在 99 项研究中，有 231 项方案报告了全心脏剂量。84 项研究（196 项方案）报告了左侧乳腺癌的全心脏平均剂量为 3.6Gy，低于之前报告的剂量（5.4Gy）。在任何体位下采用呼吸控制的方案的全心脏平均剂量（1.7Gy）明显低于无呼吸控制的方案（4.5Gy）（P<.0001）。不同大陆之间的全心脏平均剂量差异显著（P<.0001），尽管欧洲各国之间存在异质性（P=.04），但其他大陆之间没有。平均而言，2014 年（4.6Gy）和 2017 年（2.6Gy）之间的全心脏平均剂量呈稳步下降趋势（P=.003）。80 项左侧方案报告了包括左前降支平均剂量在内的其他心脏剂量参数，左前降支的平均剂量为 12.4Gy。
