Abstract： At present,the heart has become an important organ at risk during radiotherapy for thoracic,mediastinal and breast carcinoma. Heart is relatively sensitive to radiation because of its anatomical location and structure. Long-term survival of patients have been affected by cardiac adverse effect post-radiotherapy. In this paper,the progress of clinical manifestations,risk factors,screening methods,prevention and treatment of radiation-induced cardiac damage were reviewed as follows.
[1] Beukema JC,van Luijk P,Widder J,et al. Is cardiac toxicity a relevant issue in the radiation treatment of esophageal cancer?[J].Radiother Oncol,2015,114(1):85-90. [2] Wang K,Eblan MJ,Deal AM,et al. Cardiac toxicity after radiotherapy for stage Ⅲ non-small-cell lung cancer:pooled analysis of dose-escalation trials delivering 70 to 90 Gy[J].J Clin Oncol,2017,35(13):1387-1394.DOI:10.1200/JCO.2016.70.0229. [3] 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[J].Int J Radiat Oncol Biol Phys,2000,48(1):169-179. [4] Taunk NK,Haffty BG,Kostis JB,et al. Radiation-induced heart disease:pathologic abnormalities and putative mechanisms[J].Front Oncol,2015,18(5):39.DOI:10.3389/fonc.2015.00039. [5] Clarke M,Collins R,Darby S,et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival:an overview of the randomized trials[J].Lancet,2005,366(9503):2087-2106. [6] Mulrooney DA,Yeazel MW,Kawashima T,et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer:retrospective analysis of the Childhood Cancer Survivor Study cohort[J].BMJ,2009,339:b4606.DOI:10.1136/bmj.b4606. [7] Tukenova M,Guibout C,Oberlin O,et al. Role of cancer treatment in long-term overall and cardiovascular mortality after childhood cancer[J].J Clin Oncol,2010,28(8):1308-1315.doi:10.1200/JCO.2008.20.2267. [8] Darby SC,Ewertz M,McGale P,et a1.Risk of isehemic heart disease in women after radiotherapy for breast cancer[J].N Engl J Med,2013,368(11):987-998. [9] Stewart FA,Heeneman S,TePoele J,et al. Ionizing radiation accelerates the development of atherosclerotic lesions in ApoE-/-mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage[J].Am J Pathol,2006,168(2):649-658. [10] Mitchel RE,Hasu M,Bugden M,et al. Low-dose radiation exposure and atherosclerosis in ApoE-/-mice[J].Radiat Res,2011,175(5):665-676.DOI:10.1667/RR2176.1. [11] Fajardo LF,Stewart JR.Pathogenesis of radiation induced myocardial fibrosis[J].Lab Invest,1973,29(2):244-57. [12] Chello M,Mastroroberto P,Romano R,et al. Changes in the proportion of types I and Ⅲ collagen in the left ventricular wall of patients with post-irradiative pericarditis[J].Cardiovasc Surg,1996,4(2):222-226. [13] Marks LB,Yu X,Prosnitz RG,et al. The incidence and functional consequences of RT-associated cardiac perfusion defects[J].Int J Radiat Oncol Biol Phys,2005,63(1):214-223. [14] Schultz-Hector S.Radiation-induced heart disease:review of experimental data on dose response and pathogenesis[J].Int J Radiat Biol,1992,61(2):149-160. [15] Hardenbergh PH,Munley MT,Bentel GC,et al. Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin:preliminary results[J].Int J Radiat Oncol Biol Phys,2001,49(4):1023-1028. [16] Brosius Iii FC,Waller BF,Roberts WC.Radiation heart disease:analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart[J].Am J Med,1981,70(3):519-530. [17] Cutter DJ,Schaapveld M,Darby SC,et al. Risk for valvular heart disease after treatment for Hodgkin lymphoma[J].J Natl Cancer Inst,2015,107(4).v008.DOI:10.1093/jnci/djv008. [18] Veinot JP,Edwards WD.Pathology of radiation-induced heart disease:a surgical and autopsy study of 27 cases[J].Hum Pathol,1996,27(8):766-773. [19] Bourhis J,Habrand JL,Mornex F,et al. Secondary Effects and Complications of Radiotherapy[M].Paris:Upjohn-France,1995;81-85. [20] Glanzman C,Huguenin P,Lutolf UM,et al. Cardiac lesions after mediastinal irradiation for Hodgkin′s disease[J].Radiother Oncol,1994,30(1):43-54. [21] Hancock SL,Hoppe RT.Long-term complications of treatment and causes of mortality after Hodgkin′s disease[J].Sem Radiat Oncol,1996,6(2):225-242. [22] Ttterman KJ,Pesonen E,Siltanen P.Radiation-related chronic heart disease[J].Chest,1983,83(6):875-878. [23] Slama MS,LeGuludec D,Sebag C,et al. Complete atrioventricular block following mediastinal irradiation:a report of six cases[J].Pacing Clin Electrophysiol,1991,14(7):1112-1118. [24] Strender LE,Lindahl J,Larsson LE.Incidence of heart disease and functional significance of changes in the electrocardiogram 10 years after radiotherapy for breast cancer[J].Cancer,1986,57(5):929-934. [25] Ng GA.Treating patients with ventricular ectopic beats[J].Heart,2006,92(11):1707-1712.DOI:10.1136/hrt.2005.067843. [26] Kostis JB,McCrone K,Moreyra AE,et al. Premature ventricular complexes in the absence of identifiable heart disease[J].Circulation,1981,63(6):1351-1356. [27] Eldabaje R,Le DL,Huang W,et al. Radiation-associated cardiac injury[J].Anticancer Res,2015,35(5):2487-2492. [28] 何宏涛,王军,刘青,等.急性放射性心脏损伤剂量体积因素分析[J].中华肿瘤防治杂志,2014,21(10):767-770. He HT,Wang J,Liu Q,et al. Dose and volume factors to the acute radiation-induced heart disease[J].Chin J Cancer Prevent Treat,2014,21(10):767-770. [29] 王军,龙书敬,景绍武,等.胸部肿瘤放疗后急性左心室功能损伤剂量体积因素分析[J].中华放射肿瘤学杂志,2014,23(4):326-330.DOI:10.3760/cma.j.issn.1004-4221.2014.04.013. Wang J,Long SJ,Jing SW,et al. Analysis of dose-volume factors for acute left ventricular damage in patients with thoracic cancer after radiotherapy[J].Chin J Radiat Oncol,2014,23(4):326-330.DOI:10.3760/cma.j.issn.1004-4221.2014.04.013. [30] Mulrooney DA,Yeazel MW,Kawashima T,et al. Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer:Retrospective analysis of the childhood cancer survivor study cohort[J].Brit Med J,2009,339:b4606.DOI:10.1136/bmj.b4606. [31] Cosset JM,Henry-Amar M,Girinski T,et al. Late toxicity of radiotherapy in Hodgkin′s disease. The role of fraction size[J].Acta Oncol,1988,27(2):123-129. [32] McGale P,Darbv SC,HaU P,et a1.Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden[J].Radiother 0ncol,201l,100(2):167-175.DOI:10.1016/j.radonc.2011.06.016. [33] Wollschlager D,Karle H,stockinger M,et alRadiation dose distribution in functional heart regions from tangential breast cancer radiotherapy[J].Radiother 0ncol,2016,119(1):65-70.DOI:10.1016/j.radonc.2016.01.020. [34] Bouchardy c,Rapiti E,Usel M,et alExcess of cardiovascular mortalitv among node-negative breast cancer patients irradiated for inner-quadrant tumors[J].Ann 0ncol,2010,2l (3):459-465. [35] Hardy D,Liu CC,Cormier JN,et al. Cardiac toxicity in association with chemotherapy and radiation therapy 4in a large cohort of older patients with non-small-cell lung cancer[J].Ann Oncol,2010,21(9):1825-1833. [36] Cao L,Cai G,Chang C,et al. Early cardiac toxicity following adjuvant radiotherapy of left-sided breast cancer with or without concurrent trastuzumab[J].Oncotarget,2016,7(1):1042-1054. [37] Schubert LK,Gondi V,Sengbusch E,et al. Dosimetric comparison of left-sided whole breast irradiation with 3DCRT,forward-planned IMRT,inverse-planned IMRT,helical tomotherapy,and topotherapy[J].Radiother Oncol,2011,100(2):241-246. [38] 刘青,王雯,武亚晶,等.胸部肿瘤放疗后心电图异常的剂量学分析[J].临床心血管病杂志,2016,32(2):197-201. Liu Q,Wang J,Wu YJ,et al. Dose-volume parameter analysis on acute electrocardiographic changes sfter irradiation for thoracic neoplasms[J].J Clin Cardiol,2016,32(2):197-201. [39] Aznar MC,Maraldo MV,Schut DA,et al. Minimizing late effects for patients with mediastinal Hodgkin lymphoma:deep inspiration breath-hold,IMRT,or both?[J].Int J Radiat Oncol Biol Phys,2015,92(1):169-174. DOI:10.1016/j.ijrobp.2015.01.013. [40] 杨苏萍,张琴,陈甲信.胸部肿瘤放化疗后心电图改变的研究现状[J].实用心电学杂志,2008,17(3):233-234.DOI:10.3969/j.issn.1008-0740.2008.03.067. Yang SP,Zhang Q,Chen JX.Journal of Practical Electrocardiology.2008,17(3):233-234.DOI:10.3969/j.issn.1008-0740.2008.03.067. [41] Marks LB,Yu X,Prosnitz RG,et al. The incidence and functional consequences of RT-associated cardiac perfusion defects[J].Int J Radiat Oncol Biol Phys,2005,63(1):214-23.DOI:10.1016/j.ijrobp.2005.01.029. [42] Yan R,Song J,Wu Z,et al. Detection of Myocardial Metabolic Abnormalities by 18F-FDG PET/CT and Corresponding Pathological Changes in Beagles with Local Heart Irradiation[J].Korean J Radiol,2015,16(4):919-28.DOI:10.3348/kjr.2015.16.4.919. [43] Yu XL,Zhang Q,Chen JY,et al. Delineation of the cardiac substructures based on PET-CT and contrast-enhanced CT in patients with left breast cancer treated with postoperative radiotherapy[J].Technol Cancer Res Treat,2013,12(2):99-107. [44] Machann W,Beer M,Breunig,M,et al. Cardiac magnetic resonance imaging findings in 20-year survivors of mediastinal radiotherapy for Hodgkin′s disease[J].Int J Radiat Oncol Biol Phys,2011,79(4):1117-1123.DOI:10.1016/j.ijrobp.2009.12.054. [45] Umezawa R,Ota H,Takanami K,et al. MRI findings of radiation-induced myocardial damage in patients with oesophageal cancer[J].Clin Radiol,2014,69(12):1273-1279.
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