Vpliv visokodozne in nizkodozne izpostavljenosti srčnih struktur na srčno-žilne posledice obsevanja raka dojke in raka pljuč The impact of high and low cardiac substructure dose levels on cardiac toxicity in lung and breast cancer radiotherapy

Povzetek

Z daljšanjem preživetja bolnikov z rakom so postale srčno žilne bolezni pomemben del morbiditete in mortalitete teh bolnikov. V zadnjih letih je v literaturi veliko zanimanja na področju vpliva radioterapije na pozne posledice na srcu. Objavljene so različne dozno-volumske omejitve na srce v povezavi z srčno žilnimi obolenji in smrtnostjo, vendar te omejitve niso enotno veljavne. Pri dopolnilnem obsevanju raka dojk je celotno srce izpostavljeno nizki dozi in se pomembne srčne okvare najpogosteje izrazijo v desetletju po zdravljenju ali še kasneje. V primeru visokodozne izpostavjenosti pri radikalnem obsevanju pljuč pa je smrtnost zaradi srčno žilnih dogodkov povišana že v prvih letih po zdravljenju. Z nižanjem doze na srce lahko še dodatno vplivamo na preživetje bolnikov po obsevanju, kar nam že omogočajo boljše obsevalne tehnike in slikovno vodena radioterapija. Dodatno dobrobit lahko pridobimo še z boljšim razumevanjem in upoštevanjem vpliva obsevanja na posamezne srčne strukture, tudi v povezavi z pridruženimi boleznimi, in z usmerjenim kardiološkim spremljanjem bolnikov po obsevanju prsnega koša.

Abstract (Eng)

With improved survival outcomes of patients with cancer, cardiovascular diseases have become an important part of morbidity and mortality. In recent years, there has been much interest in the literature on the impact of radiotherapy on the late cardiac toxicity. Various cardiac dose-volume constraints have been reported in association with cardiovascular events and mortality, but without consistent constraint. Low-dose heart exposure in adjuvant breast cancer radiotherapy can lead to important cardiac events in decade or more after treatment. However, in radical lung cancer radiotherapy, high-dose heart exposure can lead to increased cardiovascular mortality in the first years after treatment.  We can further influence the survival of patients with cancer after chest irradiation by lowering the absorbed dose to the heart, which is already made possible by better irradiation techniques and image-guided radiotherapy. Additional benefits can be gained by better understanding and considering the impact of radiation on individual cardiac structures, also in connection with other patients’ comorbidities, and by close cardiac follow-up of patients after chest radiation therapy.