Nikovia Vasiliki, Chinis Evangelos, Gkantaifi Areti, Marketou Maria, Mazonakis Michalis, Charalampakis Nikolaos, Mavroudis Dimitrios, Orfanidou Kornilia Vasiliki, Varveris Antonios, Antoniadis Chrysostomos, Tolia Maria
Medical School, University of Crete, Vassilika, 71110 Heraklion, Greece.
Radiotherapy Department, Theagenio Anticancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece.
J Pers Med. 2023 Jun 24;13(7):1038. doi: 10.3390/jpm13071038.
Breast cancer (BC) is the most common malignancy in females, accounting for the majority of cancer-related deaths worldwide. There is well-established understanding about the effective role of radiotherapy (RT) in BC therapeutic strategies, offering a better local-regional control, prolonged survival, and improved quality of life for patients. However, it has been proven that conventional RT modalities, especially in left-sided BC cases, are unable to avoid the administration of high RT doses to the heart, thus resulting in cardiotoxicity and promoting long-term cardiovascular diseases (CVD). Recent radiotherapeutic techniques, characterized by dosimetric dose restrictions, target volume revision/modifications, an increased awareness of risk factors, and consistent follow-ups, have created an advantageous context for a significant decrease inpost-RT CVD incidence.
This review presents the fundamental role of current cardioprotective strategies in the prevention of cardiotoxic effects in left-BCRT.
A literature search was conducted up to January 2023 using the Cochrane Central Register of Controlled Trials and PubMed Central databases. Our review refers to new radiotherapeutic techniques carried out on patients after BC surgery. Specifically, a dose evaluation of the heart and left anterior descending coronary artery (LADCA) was pointed out for all the included studies, depending on the implemented RT modality, bed positioning, and internal mammary lymph nodes radiation.
Several studies reporting improved heart sparing with new RT techniques in BC patients were searched. In addition to the RT modality, which definitely determines the feasibility of achieving lower doses for the organs at risk (OARs), better target coverage, dose conformity and homogeneity, and the patient's position, characteristics, and anatomy may also affect the evaluated RT dose to the whole heart and its substructures.
Modern BC RT techniques seem to enable the administration of lower doses to the OARs without compromising on the target coverage. The analysis of several anatomical parameters and the assessment of cardiac biomarkers potentiate the protective effect of these new irradiation modalities, providing a holistic approach to the radiation-associated risks of cardiac disease for BC patients. Despite technological advances, an inevitable cardiac radiation risk still exists, while adverse cardiac events may be observed even many years after RT. Studies with longer follow-ups are required in order to determine the effectiveness of modern breast RT techniques.
乳腺癌（BC）是女性中最常见的恶性肿瘤，在全球癌症相关死亡中占大多数。放疗（RT）在BC治疗策略中的有效作用已得到充分认识，可为患者提供更好的局部区域控制、延长生存期并改善生活质量。然而，事实证明，传统的RT方式，尤其是在左侧BC病例中，无法避免对心脏给予高剂量放疗，从而导致心脏毒性并引发长期心血管疾病（CVD）。最近的放射治疗技术，其特点是剂量学剂量限制、靶区体积修订/修改、对危险因素认识的提高以及持续的随访，为显著降低RT后CVD发病率创造了有利条件。
本综述介绍了当前心脏保护策略在预防左侧BC放疗中的心脏毒性作用方面的基本作用。
截至2023年1月，使用Cochrane对照试验中央登记册和PubMed Central数据库进行了文献检索。我们的综述涉及BC手术后对患者进行的新放射治疗技术。具体而言，根据所实施的RT方式、床位定位和内乳淋巴结放疗，对所有纳入研究指出了心脏和左前降支冠状动脉（LADCA）的剂量评估。
检索到几项报告新RT技术在BC患者中改善心脏保护的研究。除了RT方式肯定决定了实现对危及器官（OARs）较低剂量、更好的靶区覆盖、剂量适形性和均匀性的可行性外，患者的体位、特征和解剖结构也可能影响对整个心脏及其亚结构评估的RT剂量。
现代BC RT技术似乎能够在不影响靶区覆盖的情况下对OARs给予较低剂量。对几个解剖参数的分析和心脏生物标志物的评估增强了这些新照射方式的保护作用，为BC患者提供了一种全面应对与放疗相关的心脏疾病风险的方法。尽管技术取得了进步，但不可避免的心脏辐射风险仍然存在，而且即使在放疗后许多年也可能观察到不良心脏事件。需要进行更长时间随访的研究，以确定现代乳腺RT技术的有效性。
