乳腺癌放射性心脏损伤及其预防措施的研究进展

Research progress on radiation-induced cardiac injury in breast cancer and its preventive measures

放疗是降低乳腺癌局部复发率和死亡率的有效手段,然而,放射性心脏损伤的远期副作用风险不容忽视。特别是左乳放疗的患者,由于心脏在放疗射野内,其心脏损伤的风险更高,进而增加放射性心脏病的发生,最终影响远期生存率和生活质量。因此预防放射性心脏损伤尤为重要,主要措施包括使用先进的放疗技术,如调强放疗、容积调强弧形放疗、深吸气屏气下放疗、俯卧位放疗、质子束放疗等,或者优化心脏亚结构的放疗计划,进而降低心脏关键结构的照射剂量。本文将分别对乳腺癌放射性心脏损伤的病理生理机制、临床表现、危险因素、预防措施的研究进展进行综述。

Radiotherapy is an effective way to reduce the local recurrence rate and mortality of breast cancer.However,the risk of long-term side effects of radiation-induced cardiac injury cannot be ignored.Especially for patients undergoing left breast radiation therapy,the risk of cardiac injury is higher due to the heart being within the radiation field,which increases the incidence of radiation induced heart disease and ultimately affects long-term survival rate and quality of life.Therefore,it is particularly important to prevent radiation induced cardiac injury.The main measures include using advanced radiation therapy techniques such as intensity modulated radiation therapy,volume modulated arc radiotherapy,deep inhalation and breath holding radiation therapy,prone position radiation therapy,proton beam therapy,etc.or optimizing the radiotherapy plan for cardiac substructure to reduce the radiation dose to key cardiac structures.This article will review the research progress of pathophysiological mechanism,clinical manifestations,risk factors and preventive measures of radiation-induced cardiac injury in breast cancer.