JCO:放疗增加乳腺癌患者发生冠脉狭窄的风险
2012-01-01 巩睿智 生物谷
(图片来源:Medpage Today) 瑞典乌普萨拉大学的Greger Nilsson博士等近日在《临床肿瘤学杂志》(Journal of Clinical Oncology)发表论文称,接受乳腺癌放射治疗的患者,其暴露区域的冠状动脉更易发生狭窄或堵塞。 作者称,接受放疗的左侧乳腺癌患者,其暴露区域的冠状动脉中远段和左前降支的对角支远端发生狭窄和堵塞的风险显着高于右侧乳腺癌患者。放疗被认为可
(图片来源:Medpage Today)
瑞典乌普萨拉大学的Greger Nilsson博士等近日在《临床肿瘤学杂志》(Journal of Clinical Oncology)发表论文称,接受乳腺癌放射治疗的患者,其暴露区域的冠状动脉更易发生狭窄或堵塞。
作者称,接受放疗的左侧乳腺癌患者,其暴露区域的冠状动脉中远段和左前降支的对角支远端发生狭窄和堵塞的风险显着高于右侧乳腺癌患者。放疗被认为可增加暴露区域冠脉发生3至5级狭窄的风险。
众所周知放疗科改善乳腺癌患者的预后,但之前有研究证实其可增加患者发生心血管疾病的风险。研究者对199名侵袭性乳腺癌或原位导管癌患者进行了冠状动脉造影检查,这些患者中有62%曾接受过放疗。
分析结果发现,左侧乳腺癌放疗与右冠脉狭窄无显着相关性,但与冠状动脉中远段和左前降支的对角支远端发生狭窄相关:1至5级狭窄的OR值为2.04,3至5级狭窄的OR值为4.38,4至5级狭窄的OR值为7.22。
作者称,射线诱导的心脏疾的病理生理涉及微血管病变和大血管病变(冠脉病变),导致心肌纤维化,冠状动脉疾病,最终导致缺血性心肌病的发生。
因此,作者建议将冠状动脉作为放疗的高风险器官,并尽可能地采取措施来减少冠状动脉所承受的辐射剂量。(生物谷bioon.com)
Distribution of Coronary Artery Stenosis After Radiation for Breast Cancer
Greger Nilsson, Lars Holmberg, Hans Garmo, Olov Duvernoy, Iwar Sjögren,Bo Lagerqvist and Carl Blomqvist.
Purpose To study distribution of coronary artery stenosis among patients with breast cancer (BC) and to assess correlation between radiotherapy (RT) and location of stenosis.
Patients and Methods A Swedish BC cohort diagnosed from 1970 to 2003 was linked to registers of coronary angiography from 1990 to 2004, which yielded 199 patients. Stenoses of the coronary arteries were graded from 0 to 5, where 0 indicated a normal vessel and 5 indicated occlusion. Two hotspot areas for radiation were defined: proximal right coronary artery (prox RCA), mid and distal left anterior descending artery and distal diagonal (mdLAD + dD). RT regimens were categorized as high or low risk of irradiating the hotspot areas. Left breast/chest wall was considered high risk for mdLAD + dD; left internal mammary chain (IMC), high risk for prox RCA and mdLAD + dD from 1970 to 1995 and thereafter solely for mdLAD + dD; and right IMC, high risk for prox RCA. Other RT targets and no RT were considered low risk. Results were expressed in odds ratios (ORs) and 95% CIs.
Results For irradiated left- versus right-sided BC, the OR for grade 3 to 5 stenosis in mdLAD + dD was 4.38 (95% CI, 1.64 to 11.7), and for grade 4 to 5 stenosis, the OR was 7.22 (95% CI, 1.64 to 31.8). For high-risk RT versus low-risk or no RT, the OR for grade 3 to 5 stenosis in hotspot areas was 1.90 (95% CI, 1.11 to 3.24).
Conclusion An increase of stenosis in mdLAD + dD in irradiated left-sided BC and an association between high-risk RT and stenosis in hotspot areas for radiation indicate a direct link between radiation and location of coronary stenoses.
作者:巩睿智
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