胸部肿瘤放射治疗中心脏照射剂量体积与损伤效应的关系

放射治疗是胸部肿瘤综合治疗的重要组成部分,但其具有明确的致心脏损伤作用。随着放射治疗主流技术的进步,胸部肿瘤放射治疗中心脏照射的剂量体积分布特点发生了转变。放射相关性心脏疾病（radiation-related heart diseases, RRHDs）的发生显著减少,但在以调强放射治疗为主流的精确治疗时代仍不能确保绝对的心脏安全。本文综述了心脏照射剂量体积分布对放射性心脏损伤风险的影响及心脏照射剂量体积评价指标,并对影响心脏照射剂量体积分布的技术因素及放射相关心脏疾病的监测方法进行了探讨。     

乳腺癌放射治疗对心脏影响的评估：附33例临床分析

乳腺癌放射治疗虽然随设备技术及治疗方法的改进,其不良反应及并发症大大减轻。但近年来,越来越多的证据表明,放射治疗对心脏有一定程度的损害。本文作者旨在通过心肌酶谱的检测来评估这种影响。     

乳腺癌放射治疗的心脏损伤研究进展

放射治疗是乳腺癌综合治疗的重要组成部分，以往放射治疗技术使患者死于心血管疾病的几率增高，随着放射治疗技术的改进，放射治疗后心脏损伤有所降低。本文介绍了放射治疗技术进展对减轻心脏放射损伤的研究，分析影响乳腺癌患者心脏放射损伤的主要因素，回顾相关机构分析心脏损伤的研究结果，并对可能的原因以及减少心脏损伤措施进行探讨。     

乳腺癌放射治疗放射性心脏损伤的研究状况

放射治疗是恶性肿瘤尤其是乳腺癌的重要治疗方法之一,在乳腺及胸壁接受放射治疗的过程中,设计照射野时常不能完全避开心脏,即使在使用三维适形或/和三维适形调强放疗的情况下,心脏也不可避免地受到不同程度的照射,从而引起放射性心脏损伤(RIHD).目前已成为乳腺癌治疗的重要临床并发症,同时也是影响乳腺癌患者治疗疗效的重要因素之一.本文就乳腺癌放射性心脏损伤的临床表现、病理、影响因素、检查手段、预防治疗的研究状况作一简要综述.     

放射性心脏损伤发生机制及潜在干预措施的研究进展

摘 要：放射性心脏损伤是胸部肿瘤放射治疗中的常见并发症,其发生机制为线粒体等细胞微观结构改变、毛细血管受损、炎症与纤维化,临床相关影响因素有放射物理、药物联合使用、心肺相互作用,文章在此基础上对可能的干预措施进行讨论。     

心脏横纹肌肉瘤立体定向放射治疗一例

心脏横纹肌肉瘤极为罕见 ,我院收治 1例心脏横纹肌肉瘤 ,经立体定向放射治疗及对症治疗后病情明显好转。总结报告及介绍护理体会。1　病情介绍患者男 ,44岁。 1年前无明显原因胸闷、憋气 ,伴全身乏力 ,经心电图检查示Ⅰ～Ⅱ度房室传导阻滞 ,诊断为病毒性心肌炎 ,给予护心通、阿     

放射性心脏损伤发病机制研究进展

在Medline及CNKI数据库里以“放射性心脏损伤、损伤通路、发病机制、干预”等为关键词检索相关文献37篇。放射性心脏损伤发生可能与氧化应激、转化生长因子-β、肾素血管紧张素系统、肥大细胞、内皮功能障碍等多种机制相关。放射性心脏损伤的发生是多种机制参与的复杂过程,目前针对其发生的细胞、分子学机制及干预措施正在研究中。     

乳腺癌放射性心脏损伤(RIHD)的评估和预防研究进展

放疗为乳腺癌术后辅助治疗的重要组成部分,但乳腺癌术后放疗存在心脏损伤的潜在风险。本文就放射相关性心脏损伤的概况、诊断与评价指标、危险因素、放疗的影响因素和有效防护措施进行综述。     

胸上段食管癌放疗致急性心脏损伤1例

放射治疗(简称放疗)是食管癌、肺癌、乳腺癌及纵膈淋巴瘤等胸部恶性肿瘤的主要治疗手段之一,近年来随着放疗技术的不断改进,生存率有了明显提高,但在放疗过程中,心脏不可避免地受到放射线的照射,引起心脏损伤,由此降低患者的生活质     

44例胸部恶性肿瘤放疗后心电图异常的临床观察

目的 探讨放射治疗胸部肿瘤尤其是左肺癌时对心脏的影响因素。方法 对1933年1月至1984年12月收治的胸部恶性肿瘤44例,在放疗前、放疗中和放疗结束时分别作心电图检查。左肺癌38例,右肺癌2例,其他肿瘤4例。浣野放疗30例,大面积不规则野放疗14例;加速超分割放疗5例,大面积不规则野放疗14例,常规野规放疗25例;＜55Gy19例,≥55Gy25例。结果 本组心电图异常发生率为43．2％（19／44）,其中心动过速27．3％,心动过缓4．5％,S－T段下移6．8％,传导阻滞4．5％。左下肺癌心电图异常率远远高于其他胸肿瘤（P＜0．01）;≥55Gy组高于＜55Gy组（P＜0．05）;加速超分割照射组明显高于常规分割照射组（P＜0．01）。结论 放射治疗期间可发生急性放射性心脏损伤,其损伤程度与心脏受照体积、放射剂量、分割方式有关。超分割、加速超分割照射胸部肿瘤尤其是左肺癌时应当慎重。     

肿瘤患者纵隔放疗对左心室收缩功能影响的研究

本文对３９例恶性肿瘤患者纵隔放疗前后左心室收缩时间间期进行测定，了解心脏受ｒ射线照射后对左室射血功能的即时影响，以期发现放射线引起心功能早期改变的线索。结果表明常规剂量分割放疗，心肌ＴＤ５／５剂量范围内，心功能敏感指标放疗前及放疗后即时无差异，但随访全程放疗结束后２５例病人心功能各项指标，其中应用心脏毒性药物化疗后再行放疗者部分病人心功能发生异常。     

植入永久心脏起搏器肿瘤患者的放射治疗:附4例报告

背景与目的：植入永久心脏起搏器的患者数量呈上升趋势,这其中有一部分是需要放射治疗的肿瘤患者。本文回顾性地总结了植入永久心脏起搏器的肿瘤患者接受放射治疗的经验,同时评价疗效。方法：植人永久心脏起搏器的肿瘤患者4例,其中男性2例,女性2例;年龄70～81岁。3例为Ⅲ度房室传导阻滞,被植人心室起搏器(VVI),1例为冠心病,病窦综合征,被植入双腔起搏器(DDDR)。4例患者全部经病理证实,分别为食道癌、非霍奇金淋巴瘤、非小细胞肺癌和鼻咽癌。用^60Co或6～8MVX直线加速器局部放疗40～70Gy,放疗期间心电监护起搏器的情况。结果：4例患者均完成了放疗,部分缓解(PR)3例,病情稳定(SD)1例;继续接受全身化疗3例,1例复发后行二程放疗。随访10个月以上,动态心电图复查示起搏器感知良好。结论：根据照射野包括起搏器及内容物与否,来选择射线和制定照射剂量,4例肿瘤患者均能耐受放射治疗,且起搏器功能正常。     

放疗与肿瘤免疫

肿瘤微环境中的免疫细胞和细胞因子在抗肿瘤免疫中具有不同功能。放疗可通过放射生物效应杀伤肿瘤细胞,同时还能间接改变肿瘤免疫微环境,协同产生局部或远处抗肿瘤免疫效应。放疗联合免疫治疗的动物和临床试验证实其良好的应用前景,联合治疗时具体的放射治疗模式尚需进一步研究。     

Graves‘眼病的放射治疗

目的 :分析 Graves'眼病的放射治疗疗效。材料与方法 :196 4年～ 1992年间收治 94例Graves'眼病患者 ,其中 90例为双侧突眼 ,4例为单侧病变。放疗剂量 9～ 2 5 Gy。结果 :总有效率为 83% ,眼睑水肿 ,眼痛等放疗后改善明显 ,特别是急性水肿和病程较短者效果更好。照射野包括垂体与否对疗效无明显影响 ,无明显副作用。结论 :放疗是 Graves'眼病有效的治疗方法 ,合并甲亢的 Graves'眼病放疗效果较差。放疗剂量 2 0～ 2 5 Gy/ 3周疗效较好。     

A Systematic Review of Heart Dose in Breast Radiotherapy

Radiotherapy (RT) for breast cancer improves survival, but poses risk to the heart, resulting from a linear relationship between RT dose and heart disease. This review presents studies worldwide reporting heart doses from whole breast RT after 2014 to update a previous systematic review (Taylor et al, Int J Radiat Oncol Biol Phys, 2015) in order to determine patterns of current heart dosimetry among varying RT regimens. Studies published between January 2014 and September 2017 were included if they reported whole heart dose based on whole breast RT technique or treatment position and had a sample size of ≥ 20 patients. Studies reporting brachytherapy, proton RT only, or boost to tumor bed were excluded. Among 99 studies, whole heart dose was reported by 231 regimens. The mean heart dose for left-sided breast cancer, reported by 84 studies (196 regimens), was 3.6 Gy, compared with a review of those previously reported (5.4 Gy). Regimens employing breathing control in any position had a significantly lower mean heart dose (1.7 Gy) compared with regimens without breathing control (4.5 Gy) (P < .0001). The mean heart dose varied significantly between continents (P < .0001), with heterogeneity reported among countries within Europe (P = .04) although not within other continents. On average, the mean heart dose steadily decreased between 2014 (4.6 Gy) and 2017 (2.6 Gy) (P = .003). Other heart dose parameters including the mean dose to the left anterior descending artery were reported by 80 left-sided regimens, and the mean left anterior descending artery dose was 12.4 Gy.     

Hematologic Toxicity of Conformal Radiotherapy and Intensity Modulated Radiotherapy in Prostate and Bladder Cancer Patients

Background: The purpose of this study was to compare hematologic adverse effects and hematologic toxicity(HT) of pelvic irradiation in patients treated with conformal radiotherapy (CRT) and intensity modulated radiotherapy(IMRT) for radical treatment of prostate and bladder cancer. Methods: A group of 115 patients with prostate or bladdercancer treated with definitive radical radiotherapy was evaluated retrospectively. Blood test were taken before andafter treatment comprising of following indices: white blood cells (WBC) hemoglobin (HGB), red blood cell (RBC),lymphocyte (LC), neutrophil (NC) and platelet (PLT) count. Patients were divided into several subgroups and the datawas evaluated statistically using absolute and relative values. Results: There was a statistically significant differencein WBC (p=0.007), NC (p=0.031) and PLT (p=0.026) count decrease (absolute values) after treatment, between twotreatment methods (CRT and IMRT), all in favor of IMRT. The relationship still proves to be significant regardingWBC (p=0,02) and (NC) (p=0,049) after presenting the data as relative percentage loss of starting value. Howeverusing Common Terminology Criteria for Adverse Effects (CTCAE), PLT count toxicity was more common in IMRTgroup (p=0.045). Conclusion: IMRT in comparison to CRT in bladder and prostate cancer patients is associated with alesser absolute and relative decrease of hematologic indices. The hematologic effect of radiation was observed mainlyregarding LC. Patients treated with IMRT suffered from significantly lesser decrease in relative and absolute valuesof WBC and NC. The mean of absolute PLT decrease count was lower in IMRT group; however, toxicity according toCTCAE was slightly more prevalent in IMRT group.     

Radiotherapy for lung cancer

The role of radiation therapy in the management of lung cancer was reviewed at a workshop held in Cambridge, England, in June 1984. It was concluded that there was a continuing role for radiation therapy in the primary management of small cell lung cancer, including the loco-regional treatment for patients with limited disease. Radical radiotherapy for patients with non-small cell carcinoma could be curative for a proportion of patients with limited disease. Careful planning and quality control was essential. Palliative radiotherapy provided useful treatment for many other patients. Other related aspects of treatment are also presented.     

PET-CT与CT对左乳癌术后辅助放疗患者心脏主要亚结构勾画的差异分析

目的研究PET-CT与CT对左乳癌术后辅助放疗患者心脏主要亚结构勾画的差异。方法采用纵向列研究设计方法,将88例左乳癌患者随机分为试验组44例和对照组44例。对照组患者进行左乳癌术后CT辅助放疗患者心脏主要亚结构勾画,而试验组则接受左乳癌术后PET-CT辅助放疗患者心脏主要亚结构勾画。收集整理2组患者临床资料,比较利用CT及PET-CT定位后的左乳癌术后辅助放疗患者心脏主要亚结构勾画差异。结果分别测量试验组和对照组的88例患者的左心室的体积,结果发现对照组CT定位的左心室的体积均值为115.7 m^3;试验组PET-CT定位的左心室的体积均值为96.8 m^3。结论 PET-CT可以作为一种有效的方法对左乳癌术后辅助放疗患者心脏主要亚结构进行勾画。PET-CT进行图像定位明显优于CT图像的定位,更加精确,可以为临床治疗提供更有效的依据,适合广泛推广。