Armanious Merna A, Mohammadi Homan, Khodor Sara, Oliver Daniel E, Johnstone Peter A, Fradley Michael G
Division of Cardiovascular Medicine, University of South Florida, Tampa, FL 33606; Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612.
Radiation-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612.
Curr Probl Cancer. 2018 Jul;42(4):433-442. doi: 10.1016/j.currproblcancer.2018.05.008. Epub 2018 Jun 12.
Radiation therapy (RT) plays a prominent role in the treatment of many cancers. With increasing use of RT and high overall survival rates, the risks associated with RT must be carefully considered. Of these risks, the cardiovascular and autonomic toxicities have been of significant concern. In fact, cardiovascular disease is the leading cause of nonmalignancy-related death in cancer survivors. The manifestations of radiation induced cardiac injury include the acute toxicities of myopericarditis and late toxicities including constrictive pericarditis, restrictive cardiomyopathy, coronary artery disease, valvular heart disease, heart failure, and conduction abnormalities. Neck and cranial RT have also been associated with significant long-term toxicities including accelerated occlusive carotid artery disease, autonomic dysfunction due to baroreceptor damage, and development of metabolic syndromes due to damage to the hypothalamic-pituitary axis. The clinical manifestations of radiation induced disease may not present until several years following the delivery of radiation. We review the adverse effects of RT on these organ systems and discuss risk reduction strategies that may effectively mitigate some of these adverse outcomes.
放射治疗（RT）在许多癌症的治疗中发挥着重要作用。随着放射治疗使用的增加和总体生存率的提高，必须仔细考虑与放射治疗相关的风险。在这些风险中，心血管和自主神经毒性一直备受关注。事实上，心血管疾病是癌症幸存者中非恶性肿瘤相关死亡的主要原因。放射诱发心脏损伤的表现包括急性心肌心包炎毒性和晚期毒性，如缩窄性心包炎、限制性心肌病、冠状动脉疾病、瓣膜性心脏病、心力衰竭和传导异常。颈部和颅脑放射治疗也与显著的长期毒性有关，包括加速性闭塞性颈动脉疾病、由于压力感受器损伤导致的自主神经功能障碍以及由于下丘脑-垂体轴损伤导致的代谢综合征的发生。放射诱发疾病的临床表现可能在放疗后数年才会出现。我们回顾了放射治疗对这些器官系统的不良影响，并讨论了可能有效减轻其中一些不良后果的风险降低策略。
