【摘要】：放射治療是乳腺癌的重要治療手段,由于左乳與心臟位置毗鄰,設(shè)計(jì)照射野時(shí)常不能完全避開(kāi)心臟。乳腺癌放射治療增加了患缺血性心臟病、心包炎和瓣膜病的風(fēng)險(xiǎn)。年輕、高體重指數(shù)(body mass index,BMI)、腫瘤位于中央象限和胸骨旁區(qū)域與心臟受到高劑量輻射有關(guān)。放療心臟毒性與放療技術(shù)有很大關(guān)系,對(duì)于左乳切除術(shù)后放療,多野調(diào)強(qiáng)適形放療(IMRT)能夠平衡靶區(qū)覆蓋和正常組織受量,而左乳保乳術(shù)后放療,采用雙弧度容積旋轉(zhuǎn)調(diào)強(qiáng)(VMAT)較多野IMRT更具優(yōu)勢(shì)。相比全乳照射,加速部分乳腺照射能夠顯著降低心臟劑量;而對(duì)于需要照射區(qū)域淋巴結(jié)的患者,采用容積旋轉(zhuǎn)調(diào)強(qiáng)或螺旋斷層放療在減少心臟受量方面則顯示出優(yōu)勢(shì)。相比自由呼吸,深吸氣屏氣放療能夠顯著減少心臟和冠狀動(dòng)脈左前降支劑量;尤其是對(duì)于胸壁+區(qū)域淋巴結(jié)(包括內(nèi)如淋巴結(jié))放療的患者采用深吸氣屏氣(deep inspiration breath hold,DIBH)放療獲益更多,而對(duì)于保乳術(shù)后仍為大乳腺的患者,采用俯臥位能減少心臟毒性。另外,左乳放療期間同步曲妥珠單抗靶向治療、芳香化酶抑制劑(aromatase inhibitors,AI)會(huì)影響心臟事件的發(fā)生�；谏鲜鲆蛩�,在給左側(cè)乳腺癌患者制定放療計(jì)劃時(shí),應(yīng)結(jié)合患者年齡、BMI、原發(fā)腫瘤位置、體型、術(shù)后乳腺大小、是否需要區(qū)域淋巴結(jié)照射,根據(jù)現(xiàn)有放療設(shè)備,給予最優(yōu)的放療方案,同時(shí)減少增加心臟毒性的同步治療,從而最大程度減少治療導(dǎo)致的心臟不良反應(yīng)。
[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.
【作者單位】： 昆明醫(yī)科大學(xué)第三附屬醫(yī)院 云南省腫瘤醫(yī)院放射治療中心;
【基金】：云南省衛(wèi)生內(nèi)設(shè)研究機(jī)構(gòu)項(xiàng)目(2014NS010,2014NS012) 云南省教育廳重點(diǎn)項(xiàng)目(2015Z090)
【分類(lèi)號(hào)】：R737.9

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