Heart toxicity from breast cancer radiotherapy : Current findings, assessment, and prevention.
Heart toxicity from breast cancer radiotherapy : Current findings, assessment, and prevention.
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DOI：
10.1007/s00066-018-1378-z
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发表时间：
2019-01
期刊：
影响因子：
--
通讯作者：
Sauer R
中科院分区：
文献类型：
--
作者：
Piroth MD;Baumann R;Budach W;Dunst J;Feyer P;Fietkau R;Haase W;Harms W;Hehr T;Krug D;Röser A;Sedlmayer F;Souchon R;Wenz F;Sauer R
晚期心脏毒性引起的（特别是左侧）乳腺放疗（RT），现在被认为是罕见的，但相关的后遗症，这促使研究的风险结构识别和阈值剂量的定义，以心脏亚体积。本综述的目的是根据平均心脏剂量以及心脏亚结构剂量的剂量依赖性结局报告，对晚期心脏反应的临床证据进行批判性讨论。进行了文献综述，以检查放射诱导心脏毒性的临床证据。基于剂量依赖性结局报告，重点关注平均心脏剂量和心脏亚结构剂量。此外，辐射技术的心脏保护的概述和非放射性方面的心脏毒性在乳腺癌治疗的多模式设置进行了讨论。根据现有的研究结果，DEGRO乳腺癌专家小组建议以下限制：平均心脏剂量<2.5戈伊; DmeanLV（左心室平均剂量）< 3戈伊; V5 LV（接受≥5戈伊的LV体积）< 17%; V23 LV（接受≥23戈伊的LV体积）< 5%; D平均LAD左降支平均剂量< 10戈伊，V30 LAD ≥30戈伊< 2%，V40 LAD ≥40戈伊<1%。除平均心脏剂量外，乳腺癌RT治疗计划还应包括LV和LAD等心脏子体积的约束。给定的约束条件可作为临床医生的辅助手段，以确保充分的心脏保护。充分保护心脏结构与最佳靶体积覆盖之间的个人决定仍然掌握在医生手中。乳腺癌特异性死亡率的风险和患者的心脏风险因素必须与辐射诱导的心脏毒性风险单独权衡。
Late cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures. A literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed. Based on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%. In addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians’ aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician’s hand. The risk of breast cancer-specific mortality and a patient’s cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.
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影响因子：
158.5
作者：
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通讯作者：
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DOI：
10.1016/j.ijrobp.2010.01.004
发表时间：
2011-04-01
影响因子：
7
作者：
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通讯作者：
Voigt, Jens-Uwe