Moving beyond mean heart dose: The importance of cardiac substructures in radiation therapy toxicity.

IF 2.2 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Medical Imaging and Radiation Oncology Pub Date : 2024-09-03 DOI:10.1111/1754-9485.13737
Sarah Bowen Jones, Tom Marchant, Chris Saunderson, Alan McWilliam, Kathryn Banfill
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Abstract

Normal tissue tolerance dose limits to the heart have been established to reduce the risk of radiation-induced cardiac disease (RICD). Dose constraints have been developed based on either the mean dose delivered to the whole heart (MHD) or the dose delivered to a specific volume, for example, volume of heart receiving equal to or greater than 30 Gy (V30). There is increasing evidence that the impact of thoracic radiation on cardiac morbidity and mortality has been underestimated. Consequently, there is a need to reduce the dose delivered to the heart in radical radiotherapy treatment planning. The pathophysiology of RICD may relate to dose to specific cardiac substructures (CS) rather than the traditionally observed MHD for common toxicities. The MHD or V30 Gy threshold dose rarely represents the true dose delivered to individual CS. Studies have shown the dose to specific areas may be more strongly correlated with overall survival (OS). With advances in modern radiotherapy techniques, it is vital that we develop robust, evidence-based dose limits for CS, to fully understand and reduce the risk of RICD, particularly in high-risk populations with cardiac risk factors. The following review will summarise the existing evidence of dose limits to CS, explain how dose limits may vary according to different disease sites or radiation techniques and propose how radiotherapy plans can be optimised to reduce the dose to these CS in clinical practice.

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超越平均心脏剂量:心脏亚结构在放射治疗毒性中的重要性。
为降低辐射诱发心脏病(RICD)的风险,已制定了心脏正常组织容许剂量限值。剂量限制的制定依据是投射到整个心脏的平均剂量(MHD)或投射到特定体积的剂量,例如,接受等于或大于 30 Gy 的心脏体积(V30)。越来越多的证据表明,胸部辐射对心脏发病率和死亡率的影响被低估了。因此,有必要在根治性放疗治疗计划中减少心脏接受的剂量。RICD的病理生理学可能与特定心脏亚结构(CS)的剂量有关,而非传统上观察到的常见毒性的MHD。MHD或V30 Gy阈值剂量很少代表单个CS的真实剂量。研究表明,特定区域的剂量可能与总生存率(OS)有更密切的关系。随着现代放疗技术的发展,我们必须为CS制定可靠的、以证据为基础的剂量限值,以充分了解并降低RICD的风险,尤其是在有心脏风险因素的高危人群中。以下综述将总结 CS 剂量限值的现有证据,解释不同疾病部位或放疗技术的剂量限值可能存在的差异,并提出在临床实践中如何优化放疗计划以减少这些 CS 的剂量。
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来源期刊
CiteScore
3.30
自引率
6.20%
发文量
133
审稿时长
6-12 weeks
期刊介绍: Journal of Medical Imaging and Radiation Oncology (formerly Australasian Radiology) is the official journal of The Royal Australian and New Zealand College of Radiologists, publishing articles of scientific excellence in radiology and radiation oncology. Manuscripts are judged on the basis of their contribution of original data and ideas or interpretation. All articles are peer reviewed.
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