Niska Joshua R, Thorpe Cameron S, Allen Sorcha M, Daniels Thomas B, Rule William G, Schild Steven E, Vargas Carlos E, Mookadam Farouk
a Mayo Clinic - Department of Radiation Oncology , Phoenix , AZ , USA.
b Mayo Clinic - Department of Cardio-Oncology , Scottsdale , AZ , USA.
Expert Rev Cardiovasc Ther. 2018 Dec;16(12):931-950. doi: 10.1080/14779072.2018.1538785. Epub 2018 Nov 1.
Recent trials in radiotherapy have associated heart dose and survival, inadequately explained by the existing literature for radiation-related late cardiac effects. Authors aimed to review the recent literature on cardiac dosimetry and survival/cardiac endpoints. Areas covered: Systematic review of the literature in the past 10 years (2008-2017) was performed to identify manuscripts reporting both cardiac dosimetry and survival/cardiac endpoints. Authors identified 64 manuscripts for inclusion, covering pediatrics, breast cancer, lung cancer, gastrointestinal diseases (primarily esophageal cancer), and adult lymphoma. Expert commentary: In the first years after radiotherapy, high doses (>40 Gy) to small volumes of the heart are associated with decreased survival from an unknown cause. In the long-term, mean heart dose is associated with a small increased absolute risk of cardiac death. For coronary disease, relative risk increases roughly 10% per Gy mean heart dose, augmented by age and cardiac risk factors. For valvular disease and heart failure, doses >15 Gy substantially increase risk, augmented by anthracyclines. Arrhythmias after radiotherapy are poorly described but may account for the association between upper heart dose and survival. Symptomatic pericardial effusion typically occurs with doses >40 Gy. Close follow-up and mitigation of cardiovascular risk factors are necessary after thoracic radiotherapy.
近期放疗试验已将心脏剂量与生存率联系起来，而现有关于辐射相关晚期心脏效应的文献对此解释并不充分。作者旨在回顾近期关于心脏剂量测定与生存率/心脏终点的文献。涵盖领域：对过去10年（2008 - 2017年）的文献进行系统综述，以确定报告心脏剂量测定及生存率/心脏终点的手稿。作者确定了64篇纳入文献，涵盖儿科、乳腺癌、肺癌、胃肠道疾病（主要是食管癌）及成人淋巴瘤。专家评论：在放疗后的最初几年，小体积心脏接受高剂量（>40 Gy）照射与不明原因的生存率降低相关。从长期来看，平均心脏剂量与心脏死亡的绝对风险小幅增加相关。对于冠心病，平均心脏剂量每增加1 Gy，相对风险大约增加10%，年龄和心脏危险因素会加剧这种情况。对于瓣膜病和心力衰竭，剂量>15 Gy会大幅增加风险，蒽环类药物会加剧这种情况。放疗后心律失常的描述较少，但可能是上半部分心脏剂量与生存率之间关联的原因。有症状的心包积液通常发生在剂量>40 Gy时。胸部放疗后密切随访及减轻心血管危险因素是必要的。
