预防放疗相关性心血管毒性反应的技术实现

Technical Prevention of Radiation-induced Cardiovascular Toxicity

在生存期较长的恶性肿瘤患者中,放疗相关性心血管毒性显著影响患者生存。虽然其病理生理机制尚未明确,但研究发现心血管受累剂量和受累体积与放疗相关性心脏毒性呈正相关。因此,降低心脏受累剂量和体积是放疗心脏保护技术的关键。放疗心脏保护技术包括改变照射范围及剂量、增加心脏与照射野的距离、逆向调强放疗和质子放疗。尽管放疗心脏保护技术在剂量学上明显降低了心脏受累剂量和体积,其疗效仍需进一步验证。

Radiotherapy has been an important component of cancer treatment.In the malignancy with long survival,radiation-induced cardiovascular toxicity significantly jeopardize patients’outcome.Despite that its pathophysiological mechanism is not clear yet,many studies have confirmed the positive correlation between cardiovascular involvement dose,irradiated volume and radiation-induced cardiotoxicity.Therefore,reducing cardiovascular involvement dose as well as irradiated volume is the key to cardiac sparing techniques in radiotherapy.Cardiac sparing techniques includes:(1)methods that reduce radiation fields and dose;(2)methods that increase the distance between heart and irradiated fields;(3)new techniques such as intensity modulated radiotherapy and proton therapy.Although researches in dosimetry have showed that cardiac sparing techniques could lower cardiovascular involvement dose and irradiated volume,further validation is needed for curative effect.