心脏放射暴露与癌症发生：挑战与机遇
Cardiac radiation exposure and incident cancer: challenges and opportunities
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影响因子:6.6
分区:医学1区 Top / 心脏和心血管系统2区 核医学2区
发表日期:2024 Nov 27
作者:
Eugenio Picano, Eliseo Vano, Robert P Gale, Patrick Serruys
DOI:
10.1093/ehjci/jeae257
摘要
放射影像技术的应用极大推动了心脏病学的发展。患有心脏疾病的人群在诊疗过程中暴露于电离辐射。根据线性无阈值模型（LNT模型），电离辐射暴露会增加终生癌症风险，剂量与风险成正比。美国在2016年的放射年度数据显示，平均每人每年接受的医疗辐射剂量中位数为2.29毫希沃特，等同于115次胸部X光。心脏相关检查常涉及高剂量，约占总医疗辐射暴露的30-50%。辐射剂量较大的器官（如肺、骨髓和女性乳腺）更易发生恶性肿瘤。辐射暴露与癌症的潜伏期至少为白血病2年，其他实体瘤5年以上，且在长期随访及包括非心血管终点（如癌症发生率）时，差异更为明显。辐射后3-12年内，癌症超额发生率明显增加，随随访时间增长，差异亦增大。这提示我们需深入研究辐射暴露与癌症风险的关系。未来的临床试验应将癌症发生作为重要终点，包括介入性透视与最佳药物治疗或手术的比较。©作者所有，2024年由牛津大学出版社代表欧洲心脏病学会出版。若需商业再使用，请联系reprints@oup.com获取转载及译权。其他权限请通过我们网站文章页面的Permissions链接，使用RightsLink服务获得——详情请联系journals.permissions@oup.com。
Abstract
The use of radiological procedures has enormously advanced cardiology. People with heart disease are exposed to ionizing radiation. Exposure to ionizing radiation increases lifetime cancer risk with a dose-proportional hazard according to the linear no-threshold model adopted for radioprotection purposes. In the USA, the average citizen accumulates a median annual medical radiation exposure of 2.29 millisievert per year per capita as of the radiologic year 2016, corresponding to the dose exposure of 115 chest X-rays. Cardiology studies often involve high exposures per procedure accounting for ∼30-50% of cumulative medical radiation exposures. Malignancy is more incident in the most radiosensitive organs receiving the largest organ dose from cardiac interventions and cardiovascular imaging testing, such as the lung, bone marrow, and female breast. The latency period between radiation exposure and cancer is thought to be at least 2 years for leukaemia and 5 years for all solid cancers, and differences are more likely to emerge in cardiology studies with longer follow-up and inclusion of non-cardiovascular endpoints such as cancer incidence. In cardiological studies, excess cancers are observed 3-12 years following exposure, with longer follow-up times showing greater differences in cancer incidence. The presumed associated excess cancer risk needs greater study. These exposures provide a unique opportunity to expand our knowledge of the relationship between exposure to ionizing radiation and cancer risk. Future trials comparing interventional fluoroscopy vs. optimal medical therapy or open surgery should include a cancer incidence endpoint.© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.