放射治疗中的心脏肿瘤学关注：现代递送技术引起的心脏及其亚结构毒性
Cardio-oncology concerns in radiotherapy: Heart and cardiac substructure toxicities from modern delivery techniques
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影响因子:5.6
分区:医学2区 Top / 血液学2区 肿瘤学2区
发表日期:2024 Dec
作者:
Ioana-Claudia Costin, Corina Cinezan, Loredana G Marcu
DOI:
10.1016/j.critrevonc.2024.104538
摘要
心脏肿瘤学近年来受到越来越多的关注，原因在于大量研究报道了放射引起的心脏事件。鉴于此，当前文献综述旨在涵盖过去15年的所有研究，以评估治疗演变带来的心脏剂量变化，以及在治疗计划中纳入心脏整体及其亚结构的变化。现代治疗技术，特别是质子治疗，在所有评估的肿瘤部位中均显示出优越的心脏保护效果。强度调制技术，尤其结合呼吸门控技术，在心脏的剂量体积参数方面表现出显著改善。虽然过去的研究将平均心脏剂量作为评价心脏毒性唯一的参考指标，但在计划中对其他心脏亚结构进行剂量测量的建议正变得越来越普遍。
Abstract
Cardio-oncology is lately gaining more attention due to radiation-induced cardiac events reported by a very large number of studies. In view of this, the current overview of the literature aimed to encompass all studies from the past 15 years to assess changes in cardiac dose due to treatment evolution, as well as the changes in treatment planning customs to incorporate not only the heart as a whole but also cardiac substructures. Modern treatment techniques, particularly proton therapy, offers superior cardiac sparing compared to more established radiotherapy, for all evaluated tumor sites. Intensity modulation, particularly coupled with respiratory gating shows significant improvement in dose-volume parameters pertaining to the heart. While past studies considered mean heart dose as the only reference for cardiac toxicities, recommendations for the other cardiac substructures to be dosimetrically assessed during planning are becoming more common.