左右侧乳腺癌放疗后缺血性心脏病发病的比较

Comparison of ischemic heart disease incidence between left and right breast cancer treated withpost-op radiation therapy

【摘要】目的分析比较左右侧乳腺癌辅助放疗后缺血性心脏病发病的差别。方法回顾性调查本院2006年10月至2011年12月期间住院的105例乳腺癌术后辅助放疗患者的病历资料，记录患者的治疗前临床特征、放疗分割方案、缺血性心脏病的发生及其时间，统计分析左右侧乳腺癌放疗后缺血性心脏病发病的差异。结果治疗前年龄与缺血性心脏病发病显著相关（P〈0．05），〉60岁较〈60岁患者的发病风险增加了3．84倍（P〈0．05）。左侧乳腺癌较右侧辅助放疗后缺血性心脏病发病风险有增加、提前的趋势，虽然发病风险增加了1．57倍，但差异无统计学意义（P〉0．05）。10例接受调强放射治疗的患者无缺血性心脏病发生。结论左侧乳腺癌术后辅助放疗有增加缺血性心脏病发病风险的趋势。建议左侧乳腺癌术后放疗常规应用调强放射治疗减少心脏照射剂量。

[ Abstract] Objective To compare the difference in ischemic heart disease （IHD） incidence be- tween left and right breast cancer treated with post-op radiation therapy. Methods We retrospectively re- viewed electronic database of breast cancer patients treated in our cancer center from October 2006 to De- cember 2011. Clinical data were recorded including clinical features, radiation fraction, and IHD. Statisti- cal analysis was performed to compare the difference in IHD incidence between left and right breast cancer. Results Age on diagnosis was significantly associated with IHD （ P 〈 0. 05 ）. Compare to younger patients （~〈60）, the increased hazard ratio of IHD in older patients （〉60） was 3.84. The left breast cancer pa- tients had greater incidence of IHD with the increased hazard ratio of 1.57 although this difference did not reach statistical power （ P 〉 0. 05 ）. No patients got IHD in the intensity-modulated radiation therapy group. Conclusions Left-side breast cancer patients may have more probability to get IHD after thoracic radiation therapy compared to right-side patients. We recommend that left-side breast cancer patients should be treated with intensity-modulated radiation therapy to spare heart if they receive prophylactic radiation therapy after surgery.