左侧乳腺癌放疗相关心脏毒性的危险因素分析

发布时间：2018-10-25 20:27

【摘要】：放射治疗是乳腺癌的重要治疗手段,由于左乳与心脏位置毗邻,设计照射野时常不能完全避开心脏。乳腺癌放射治疗增加了患缺血性心脏病、心包炎和瓣膜病的风险。年轻、高体重指数(body mass index,BMI)、肿瘤位于中央象限和胸骨旁区域与心脏受到高剂量辐射有关。放疗心脏毒性与放疗技术有很大关系,对于左乳切除术后放疗,多野调强适形放疗(IMRT)能够平衡靶区覆盖和正常组织受量,而左乳保乳术后放疗,采用双弧度容积旋转调强(VMAT)较多野IMRT更具优势。相比全乳照射,加速部分乳腺照射能够显著降低心脏剂量;而对于需要照射区域淋巴结的患者,采用容积旋转调强或螺旋断层放疗在减少心脏受量方面则显示出优势。相比自由呼吸,深吸气屏气放疗能够显著减少心脏和冠状动脉左前降支剂量;尤其是对于胸壁+区域淋巴结(包括内如淋巴结)放疗的患者采用深吸气屏气(deep inspiration breath hold,DIBH)放疗获益更多,而对于保乳术后仍为大乳腺的患者,采用俯卧位能减少心脏毒性。另外,左乳放疗期间同步曲妥珠单抗靶向治疗、芳香化酶抑制剂(aromatase inhibitors,AI)会影响心脏事件的发生。基于上述因素,在给左侧乳腺癌患者制定放疗计划时,应结合患者年龄、BMI、原发肿瘤位置、体型、术后乳腺大小、是否需要区域淋巴结照射,根据现有放疗设备,给予最优的放疗方案,同时减少增加心脏毒性的同步治疗,从而最大程度减少治疗导致的心脏不良反应。
[Abstract]:Radiotherapy is an important treatment for breast cancer. Because the left breast is adjacent to the heart, the design field can not avoid the heart completely. Breast cancer radiotherapy increases the risk of ischemic heart disease, pericarditis, and valvular disease. Young, high body mass index (body mass index,BMI), tumors located in the central quadrant and parasternal areas are associated with high doses of radiation to the heart. The cardiac toxicity of radiotherapy is closely related to radiotherapy technique. For post-mastectomy radiotherapy, (IMRT) can balance target coverage and normal tissue intake, while left breast conserved postoperative radiotherapy. (VMAT) with double radians volume rotation and intensity modulation has more advantages than multi-field IMRT. Compared with whole breast irradiation, accelerated partial mammary gland irradiation can significantly reduce the cardiac dose, but for patients who need regional lymph node irradiation, volume rotation intensity modulation or spiral tomography radiotherapy has advantages in reducing cardiac dose. Compared with free breathing, deep inspiratory breath-holding radiotherapy significantly reduced the dose of left anterior descending branch of the heart and coronary artery. In particular, patients with chest wall regional lymph nodes (including internal lymph nodes) receiving deep inspiratory breath-holding (deep inspiration breath hold,DIBH were more likely to benefit from radiotherapy, while those with large mammary glands after breast conserving surgery were more likely to benefit from radiotherapy. Prone position can reduce cardiac toxicity. In addition, aromatase inhibitor (aromatase inhibitors,AI) may affect cardiac events during the simultaneous targeted treatment of trotozumab during left mammary radiotherapy. Based on the above factors, when planning radiotherapy for patients with left breast cancer, we should take into account the patient's age, BMI, primary tumor location, body size, breast size after operation, whether regional lymph nodes are needed, according to the existing radiotherapy equipment. The optimal radiotherapy regimen is given while reducing the concurrent treatment of increased cardiac toxicity, thereby minimizing the adverse cardiac reactions caused by the treatment.
【作者单位】：昆明医科大学第三附属医院云南省肿瘤医院放射治疗中心;
【基金】：云南省卫生内设研究机构项目(2014NS010,2014NS012) 云南省教育厅重点项目(2015Z090)
【分类号】：R737.9

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