[1]宋建波,李思进.放射性心脏损伤临床研究进展[J].国际放射医学核医学杂志,2011,35(2):117-124.[doi:10.3760/cma.j.issn.1673-4114.2011.02.013]
 SONG Jian-bo,LI Si-jin.Advance in clinical research of radiation-induced heart disease[J].International Journal of Radiation Medicine and Nuclear Medicine,2011,35(2):117-124.[doi:10.3760/cma.j.issn.1673-4114.2011.02.013]
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放射性心脏损伤临床研究进展(/HTML)
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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
35
期数:
2011年第2期
页码:
117-124
栏目:
临床放射学
出版日期:
1900-01-01

文章信息/Info

Title:
Advance in clinical research of radiation-induced heart disease
作者:
宋建波1 李思进2
1. 030001 太原, 山西医科大学第一医院放疗科;
2. 030001 太原, 山西医科大学第一医院核医学科
Author(s):
SONG Jian-bo1 LI Si-jin2
Department of Radiation Oncology, the First Hospital of Shanxi Medical University, Taiyuau 030001, China
关键词:
心脏辐射损伤肿瘤放射疗法
Keywords:
HeartRadiation injuryNeoplasmsRadiotherapy
DOI:
10.3760/cma.j.issn.1673-4114.2011.02.013
摘要:
放射性心脏损伤(RIHD)是由胸部肿瘤放疗引起的常见迟发性不良反应之一。由于RIHD常处于亚临床状态,受照射后经过相当长潜伏期才出现症状,长期未引起临床注意。20世纪90年代,流行病学研究发现胸部肿瘤放疗增加了患者心脏病病死率,部分抵消了放疗产生的生存受益,RIHD才逐渐得到重视。随着近几十年放疗技术的改进,心脏受照剂量和体积明显下降,RIHD发病率有下降趋势。尽管如此,近期临床研究表明,在霍奇金淋巴瘤、肺癌及食管癌等恶性肿瘤放疗过程中,心脏仍会受到局部高剂量或全心低剂量的辐射,RIHD这一问题目前在临床上依然不可避免,胸部放疗患者长期心脏随访是必要的。该文对RIHD的临床表现、影响凶素、检查手段、预防治疗方法及近年来研究进展进行简要综述。
Abstract:
Radiation-induced heart disease (RIHD) is one of common late side effects derived by thoracic radiotherapy. RIHD is often subclinical and there is an extremely long clinical latent period between radiation therapy and the first clinical presentation of radiation injury, and it did not cause clinical attention for a long time. Until the 1990s, epidemiologic investigations demonstrate that thoracic cancer radiotherapy increased rates of cardiac mortality, RIHD has partly offset the survival benefit provided by adjuvant RT.Radiotherapy techniques has undergone many improvements over the last decades, these improvements decreased both the volume and dose of radiation delivered to the heart, seem to have decreased the incidence of RIHD. Nonetheless, recent studies indicate that the problem of RIHD may persist. For instance, patients with Hodgkin’s Disease, lung cancer, and esophageal may still receive either a high dose of radiation to a small part of the heart or a lower dose to the whole heart in radiotherapy. Therefore, long-term cardiac followup of these patients is essential. This article briefly review the clinical presentations, influence factors, prevention and managements, diagnosis and study advances of RIHD.

参考文献/References:

[1] Lee PJ, Mallik R. Cardiovascular effects of radiation therapy:Practical approach to radiation therapy-induced heart disease. Cardiol Rev, 2005, 13(2):80-86.
[2] Adams M J, Lipshuhz SE, Schwartz C, et al. Radiation-associated cardiovascular disease:manifestations and management. Semin Radiat Oncol, 2003, 13(3):346-356.
[3] Crower JR, Shapiro CL, Ng A, et al. American society of clinical oncology clinical evidence review on the ongoing care of adult cancer survivors:cardiac and pulmonary late effects. J Clin Oncol, 2007, 25(25):3991-4008.
[4] Heidenreich PA, Kapoor JR. Radiation induced heart disease:systemic disorders in heart disease. Heart, 2009, 95(3):252-258.
[5] Veinot JP, Edwards WD. Pathology of radiation-induced heart disease:a surgical and autopsy study of 27 cases. Hum Pathol, 1996, 27(8):766-773.
[6] Hancock SL, Donaldson SS, Hoppe RT. Cardiac disease following treatment of Hodgkin’s disease in children and adolescents. J Clin Oncol, 1993, 11(7):1208-1215.
[7] Arsenian MA. Cardiovascular sequelae of therapeutic thoracic radiation. Prog Cardiovasc Dis, 1991, 33(5):299-311.
[8] Lee CK, Aeppli D, Nierengarten ME. The need for long-term surveillance for patients treated with curative radiotherapy for Hodgkin’s disease:University of Minnesota experience. Int J Radiat Oncol Biol Phys, 2000, 48(1):169-179.
[9] Carlson RG, Mayfield WR, Normann S, et al. Radiation-associated valvular disease. Chest, 1991, 99(3):538-545.
[10] Aleman BM, van den Beh-Dusebout AW, De Bruin ML, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood, 2007, 109(5):1878-1886.
[11] Host H, Brennhovd IO, Loeh M. Postoperative radiotherapy in breast cancer long-term results from the Oslo study. Int J Radiat Oncol Biol Phys, 1986, 12(5):727-732.
[12] Lauk S, Kiszel Z, Buschmann J, et al. Radiation-induced heart disease in rats. Int J Radiat Oncol Biol Phys, 1985, 11(4):801-808.
[13] Cannel R J, Kaplan HS. Mantle irradiation in Hodgkin’s disease:An analysis of technique, tumor eradication, and complications. Cancer, 1976, 37(6):2813-2825.
[14] Glanzmann C, Huguenin P, Lütolf UM, et al. Cardiac lesions after mediastinal radiation for Hodgkin’s disease. Radiother Oncol, 1994, 30(1):43-54.
[15] Schultz-Hector S, Trott KR. Radiation-induced cardiovascular disease:is the epidemiologie evidence compatible with radiobiologic data?. Int J Radiat Oncol Biol Phys, 2007, 67(1):10-18.
[16] Swerdlow AJ, Higgins CD, Smith P, et al. Myocardial infarction mortality risk after treatment for Hodgkin disease:a collaborative british cohort study. J Natl Cancer Inst, 2007, 9(3):206-214.
[17] Paszat LF, Mackillop WJ, Groome PA, et al. Mortality from myocardial infarction after adjuvant radiotherapy for breast cancer in the surveillance, epidemiology, and end-resuhs cancer registries. J Clin Oncol, 1998, 16(8):2625-2631.
[18] Hooning M J, Botma A, Aleman BM, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst, 2007, 99(5):365-375.
[19] Pihkala J, Saarinen UM, Lundström U, et al. Myocardial function in children and adolescents after therapy with anthracyclines and chest irradiation. Enr J Cancer, 1996, 32A (1):97-103.
[20] Bovelli D, Plataniotis G, Roila F et al. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease:ESMO Clinical Practice Guidelines. Ann Oncok 2010, 21(Suppl5):v277-v282.
[21] Hull MC, Morris CG, Pepin C J, et al. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lympboma treated with radiation therapy. JAMA, 2003, 290(21):2831-2837.
[22] Boivin JF, Hutchison GB, Lubin JH, et al. Coronary artery disease mortality in patients treated for Hodgkin’s disease. Cancer, 1992, 69(5):1241-1247.
[23] Giordano SH, Kuo YF, Freeman JL, et al. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst, 2005, 97(6):419-424.
[24] Lally BE, Detterbeck FC, Geiger AM, et al. The risk of death from heart disease in patients with nonsmall cell lung cancer who receive postoperative radiotherapy:analysis of the Surveillance, Epidemiology, and End Results database. Cancer, 2007, 110(4):911-917.
[25] Harris EE, Correa C, Hwang WT, et al. Late cardiac mortality and morbidity in early-stage breast cancer patients after breast-conservation treatment. J Clin Oncol, 2006, 24(25):4100-4106.
[26] Adams M J, Hardenbergh PH, Constine LS, et al. Radiation-associated cardiovascular disease, 2003, 45(1):55-75.
[27] Nellcssen U, Zingel M, Hecker H, et al. Effects of radiation therapy on myoeardial cell integrity and pump function:which role for cardiac biomarkers?. Chemotherapy, 2010, 56(2):147-152.
[28] Kozak KR, Hong TS, Sluss PM, et al. Cardiac blood biomarkers in patients receiving thoracic (chemo) radiation. Lung Cancer, 2008, 62(3):351-355.
[29] Hughes-Davies L, Sacks D, Reseigno J, et al. Serum cardiac troponin T levels during treatment of early-stage breast cancer. J Clin Oncol, 1995, 13(10):2582-2584.
[30] Stoodley PW, Richards DA, Meikle SR, et al. The potential role of eehocardiographic strain imaging for evaluating cardiotoxicity due to cancer therapy. Heart Lung Circ, 2011, 20(1):3-9.
[31] Gyenes G, Fornander T, Carlens P, et al. Myocardial damage in breast cancer patients treated with adjuvant radiotherapy:a prospective study. Int J Radiat Oncol Biol Phys, 1996, 36(4):899-905.
[32] Gayed IW, Liu HH, Yusuf SW, et al. The prevalence of myneardial isehemia after concurrent chemoradiation therapy as detected by gated myocardial perfusion imaging in patients with esophageal cancer. J Nuel Med, 2006, 47(11):1756-1762.
[33] Gayed IW, Liu HH, Yusuf SW, et al. Patterns of cardiac perfusion abnormalities after chemoradiotherapy in patients with lung cancer. J Thorac Oncol, 2009, 4(2):179-184.
[34] Yu X, Prosnitz RR, Zhou S, et al. Symptomatic cardiac events following radiation therapy for left sided breast cancer:possible association with radiation therapy-induced changes in regional perfusion. J Clin Breast Cancer, 2003, 4(3):193-197.
[35] Yu X, Zhou S, Kahn D, et al. Persistence of radiation-induced cardiac perfusion defects 3-5 years post RT. J Clin Oncol, 2004, 22(14 Suppl):625.
[36] Marks LB, Yu X, Prosnitz RG, et al. The incidence and functional consequences of RT-associated cardiac perfusion defects, Int J Radiat Oncol Biol Phys, 2005, 63(1):214-223.
[37] Jingu K, Kaneta T, Nemoto K, et al. The utility of 18F-fluo-rodeoxyglucose positron emission tomography for early diagnosis of radiation-induced myocardial damage. Int J Radial Oncol Biol Phys, 2006, 66(3):845-851.
[38] Lee SM, Lee JJ, Kim YK, et al. Evaluation of radiation induced myocardial danmge by FDG PET. J Nucl Med, 2010, 51(2S):155.
[39] Darby SC, Cutter DJ, Boerma M, et al. Radiation-related heart disease:current knowledge and future, prospects. Int J Radiat Oncol Biol Phys, 2010, 76(3):656-665.
[40] Vallis KA, Pintilie M, Chong N, et al. Assessment of coronary heart disease morbidity and mortality after radiation therapy for early breast cancer. J Clin Oncol, 2002, 20(4):1036-1042.
[41] Gagliardi G, Constine LS, Moiseenko V, et al. Radiation dose-volume effects in the heart, Int J Radiat Oncol Biol Phys, 2010, 76(3 Suppl):S77-S85.
[42] Prosnitz RG, Marks LB. Radiation-induced heart disease:vigilance is still required. J Clin Oncol, 2005, 23(30):7391-7394.
[43] Hendry JH, Akahoshi M, Wang LS, et al. Radiation-induced cardiovascular injury. Radiat Environ Biophys, 2008, 47(2):189-193.

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备注/Memo

备注/Memo:
收稿日期:2010-09-20。
通讯作者:李思进,Email:lisj-nm@sohu.com
更新日期/Last Update: 1900-01-01