medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-8-32-39medalphabet-1507Research ArticleСтатьиСердечно-сосудистые осложнения радиотерапииCardiovascular complications of radiotherapyШавароваЕ. К.ShavarovaE. K.

доцент, кафедра внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В. С. Моисеева

г. Москва

Moscow

ШкольниковаЕ. Э.ShkolnikovaE. E.

доцент, кафедра внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В. С. Моисеева

г. Москва

Moscow

ХомоваИ. А.KhomovaI. A.

аспирант, кафедра внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В. С. Моисеева

г. Москва

Moscow

ЧерноморецВ. С.ChernomoretsV. S.

аспирант, кафедра внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В. С. Моисеева

г. Москва

Moscow

БаздыреваЕ. А.BazdyrevaE. A.

врач функциональной диагностики

г. Москва

Moscow

ФГАОУ ВО «Российский университет дружбы народов»РоссияPeople’s Friendship University of RussiaRussian FederationГБУЗ «Городская клиническая больница имени В. В. Виноградова» Департамента здравоохранения г. МосквыРоссияCity Clinical Hospital n. a. V. V. VinogradovRussian Federation20201606202008Диагностика и онкотерапия3239Copyright © Шаварова Е.К., Школьникова Е.Э., Хомова И.А., Черноморец В.С., Баздырева Е.А., 20202020Шаварова Е.К., Школьникова Е.Э., Хомова И.А., Черноморец В.С., Баздырева Е.А.Shavarova E.K., Shkolnikova E.E., Khomova I.A., Chernomorets V.S., Bazdyreva E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1507

Радиотерапия является неотъемлемой частью лечения онкологических заболеваний, в том числе при поражении органов средостения, молочной железы. При этом часто встречаются сердечно-сосудистые осложнения лечения. Долгосрочный прогноз может определяться не только эффективностью радиотерапии, но и сердечно-сосудистыми рисками. Особенностью кардиотоксичности лучевой терапии является высокая вероятность ее возникновения в отсроченном периоде – через 3–30 лет после лечения. В статье обсуждаются результаты опубликованных эпидемиологических исследований кардиотоксичности радиотерапии, а также освещены имеющиеся алгоритмы обследования пациентов, перенесших радиотерапию, с целью своевременной диагностики осложнений со стороны сердечно-сосудистой системы. Представлено собственное клиническое наблюдение раннего дебюта ишемической болезни сердца после комбинированной химиолучевой терапии В-крупноклеточной неходжкинской лимфомы.

Radiotherapy is an integral part of the cancer treatment, including with mediastinum, breast cancer. In this case, cardiovascular complications of the treatment are quite common. The long-term prognosis can be determined not only by the effectiveness of radiotherapy, but also by cardiovascular risks. A feature of cardiotoxicity of radiation therapy is the high probability of its occurrence in the delayed period of 3–30 years after treatment. The article highlights the results of published epidemiological studies of cardiotoxicity of radiotherapy, as well as the available screening algorithms for cardiovascular complications in patients who underwent radiotherapy. Own clinical observation of the early debut of coronary artery disease after combined chemoradiotherapy of diffuse large B-cell non-Hodgkin lymphoma is presented.

лучевая терапиякардиотоксичностьсердечно-сосудистые осложненияишемическая болезнь сердцаradiation therapycardiotoxicitycardiovascular complicationscoronary artery diseaseReferencesSwerdlow AJ, Higgins CD, Smith P, et al. Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst 2007; 99: 206–14.Swerdlow AJ, Higgins CD, Smith P, et al. Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst 2007; 99: 206–14.Heidenreich PA, Hancock SL, Lee BK et al. Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol 2003; 42: 743–9.Heidenreich PA, Hancock SL, Lee BK et al. Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol 2003; 42: 743–9.Wethal T, Lund MB, Edvardsen T, et al. Valvular dysfunction and left ventricular changes in Hodgkin’s lymphoma survivors. A longitudinal study. Br J Cancer 2009; 101: 575–81.Wethal T, Lund MB, Edvardsen T, et al. Valvular dysfunction and left ventricular changes in Hodgkin’s lymphoma survivors. A longitudinal study. Br J Cancer 2009; 101: 575–81.Ng AK. Review of the cardiac long-term effects of therapy for Hodgkin lymphoma. Br J Haematol 2011; 154: 23–31.Ng AK. Review of the cardiac long-term effects of therapy for Hodgkin lymphoma. Br J Haematol 2011; 154: 23–31.Patnaik JL, Byers T, DiGuiseppi C et al. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res 2011; 13: R 64.Patnaik JL, Byers T, DiGuiseppi C et al. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res 2011; 13: R 64.Darby SC., Marianne EМ., McGale P. et al. Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer NEJM 2013; 368 (11): 987–998.Darby SC., Marianne EМ., McGale P. et al. Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer NEJM 2013; 368 (11): 987–998.Ferme C, Eghbali H, Meerwaldt JH, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. N Engl J Med 2007; 357: 1916–27.Ferme C, Eghbali H, Meerwaldt JH, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. N Engl J Med 2007; 357: 1916–27.van Rijswijk S, Huijbregts MA, Lust E, Strack van Schijndel RJ. Minireview on cardiac complications after mediastinal irradiation for Hodgkin lymphoma. Neth J Med 2008; 66: 234–7.van Rijswijk S, Huijbregts MA, Lust E, Strack van Schijndel RJ. Minireview on cardiac complications after mediastinal irradiation for Hodgkin lymphoma. Neth J Med 2008; 66: 234–7.Carver JR, Shapiro CL, Ng A, et al. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 2007; 25: 3991–4008.Carver JR, Shapiro CL, Ng A, et al. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 2007; 25: 3991–4008.Aleman BM, van den Belt-Dusebout AW, De Bruin ML, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood 2007; 109: 1878–86.Aleman BM, van den Belt-Dusebout AW, De Bruin ML, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood 2007; 109: 1878–86.Early Breast Cancer Trialists’ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 2000; 355: 1757–70.Early Breast Cancer Trialists’ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 2000; 355: 1757–70.Bouillon K, Haddy N, Delaloge S, et al. Long-term cardiovascular mortality after radiotherapy for breast cancer. J Am Coll Cardiol 2011; 57: 445–52.Bouillon K, Haddy N, Delaloge S, et al. Long-term cardiovascular mortality after radiotherapy for breast cancer. J Am Coll Cardiol 2011; 57: 445–52.Hooning MJ, Botma A, Aleman BM, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst 2007; 99: 365–75.Hooning MJ, Botma A, Aleman BM, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst 2007; 99: 365–75.McGale P, Darby SC, Hall P, et al. Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol 2011; 100: 167–175.McGale P, Darby SC, Hall P, et al. Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol 2011; 100: 167–175.Brosius FC 3rd, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med 1981; 70: 519–530.Brosius FC 3rd, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med 1981; 70: 519–530.Veinot JP, Edwards WD. Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol 1996; 27: 766–773.Veinot JP, Edwards WD. Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol 1996; 27: 766–773.McEniery PT, Dorosti K, Schiavone WA et al. Clinical and angiographic features of coronary artery disease after chest irradiation. Am J Cardiol 1987; 60: 1020–1024.McEniery PT, Dorosti K, Schiavone WA et al. Clinical and angiographic features of coronary artery disease after chest irradiation. Am J Cardiol 1987; 60: 1020–1024.Jaworski et al. Cardiac Complications of Thoracic Irradiation. JACC 2013; 61 (23): 2319–28.Jaworski et al. Cardiac Complications of Thoracic Irradiation. JACC 2013; 61 (23): 2319–28.Brosius FC III, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med 1981; 70: 519–30.Brosius FC III, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med 1981; 70: 519–30.Darby SC, Ewertz M, McGale P et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368: 987–998.Darby SC, Ewertz M, McGale P et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368: 987–998.Storey MR, Munden R, Strom EA, McNeese MD, Buchholz TA. Coronary artery dosimetry in intact left breast irradiation. Cancer J 2001; 7: 492–497.Storey MR, Munden R, Strom EA, McNeese MD, Buchholz TA. Coronary artery dosimetry in intact left breast irradiation. Cancer J 2001; 7: 492–497.Prosnitz RG, Hubbs JL, Evans ES, et al. Prospective assessment of radiotherapy-associated cardiac toxicity in breast cancer patients: analysis of data 3 to 6 years after treatment. Cancer 2007; 110: 1840–1850.Prosnitz RG, Hubbs JL, Evans ES, et al. Prospective assessment of radiotherapy-associated cardiac toxicity in breast cancer patients: analysis of data 3 to 6 years after treatment. Cancer 2007; 110: 1840–1850.Gyenes G, Fornander T, Carlens P, et al. Detection of radiation-induced myocardial damage by technetium-99 m sestamibi scintigraphy. Eur J Nucl Med 1997; 24: 286–292.Gyenes G, Fornander T, Carlens P, et al. Detection of radiation-induced myocardial damage by technetium-99 m sestamibi scintigraphy. Eur J Nucl Med 1997; 24: 286–292.Brosius FC 3rd, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med 1981; 70: 519–530.Brosius FC 3rd, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med 1981; 70: 519–530.McEniery PT, Dorosti K, Schiavone WA, et al. Clinical and angiographic features of coronary artery disease after chest irradiation. Am J Cardiol 1987; 60: 1020–1024.McEniery PT, Dorosti K, Schiavone WA, et al. Clinical and angiographic features of coronary artery disease after chest irradiation. Am J Cardiol 1987; 60: 1020–1024.Orzan F, Brusca A, Conte MR, et al. Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment. Br Heart J 1993; 69: 496–500.Orzan F, Brusca A, Conte MR, et al. Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment. Br Heart J 1993; 69: 496–500.Adams MJ, Lipshultz SE, Schwartz C, et al. Radiation-associated cardiovascular disease: for Hodgkin disease in children and adolescents: report from the longitudinal GPOH follow-up project of the German-Austrian DAL-HD studies. Pediatr Blood Cancer 2010; 55: 1145–52.Adams MJ, Lipshultz SE, Schwartz C, et al. Radiation-associated cardiovascular disease: for Hodgkin disease in children and adolescents: report from the longitudinal GPOH follow-up project of the German-Austrian DAL-HD studies. Pediatr Blood Cancer 2010; 55: 1145–52.Schellong G, Riepenhausen M, Bruch C, et al. Late valvular and other cardiac diseases after different doses of mediastinal radiotherapy for Hodgkin disease in children and adolescents: report from the longitudinal GPOH follow-up project of the German-Austrian DAL-HD studies. Pediatr Blood Cancer 2010; 55: 1145–52.Schellong G, Riepenhausen M, Bruch C, et al. Late valvular and other cardiac diseases after different doses of mediastinal radiotherapy for Hodgkin disease in children and adolescents: report from the longitudinal GPOH follow-up project of the German-Austrian DAL-HD studies. Pediatr Blood Cancer 2010; 55: 1145–52.de Haas EC, Oosting SF, Lefrandt JD et al. The metabolic syndrome in cancer survivors. Lancet Oncol 2010; 11: 193–203.de Haas EC, Oosting SF, Lefrandt JD et al. The metabolic syndrome in cancer survivors. Lancet Oncol 2010; 11: 193–203.Heidenreich PA, Hancock SL, Lee BK, et al. Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol 2003; 42: 743–749.Heidenreich PA, Hancock SL, Lee BK, et al. Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol 2003; 42: 743–749.Koppelmans V, Vernooij MW, Boogerd W, et al. Prevalence of cerebral small-vessel disease in long-term breast cancer survivors exposed to both adjuvant radiotherapy and chemotherapy. J Clin Oncol 2015; 33: 588–593.Koppelmans V, Vernooij MW, Boogerd W, et al. Prevalence of cerebral small-vessel disease in long-term breast cancer survivors exposed to both adjuvant radiotherapy and chemotherapy. J Clin Oncol 2015; 33: 588–593.Ewer MS, Lenihan DJ. Left ventricular ejection fraction and cardiotoxicity: is our ear really to the ground? J Clin Oncol 2008; 26: 1201–1203.Ewer MS, Lenihan DJ. Left ventricular ejection fraction and cardiotoxicity: is our ear really to the ground? J Clin Oncol 2008; 26: 1201–1203.Lenihan DJ, Cardinale DM. Late cardiac effects of cancer treatment. J Clin Oncol 2012; 30: 3657–3664.Lenihan DJ, Cardinale DM. Late cardiac effects of cancer treatment. J Clin Oncol 2012; 30: 3657–3664.National Comprehensive Cancer Network (NCCN): Clinical Practice Guidelines in Oncology. 2010. Available at: www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf.National Comprehensive Cancer Network (NCCN): Clinical Practice Guidelines in Oncology. 2010. Available at: www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf.Heidenreich PA, Kapoor JR. Radiation induced heart disease: systemic disorders in heart disease. Heart 2009; 95: 252–8.Heidenreich PA, Kapoor JR. Radiation induced heart disease: systemic disorders in heart disease. Heart 2009; 95: 252–8.van Dalen EC, van der Pal HJ, van den Bos C, et al. Clinical heart failure during pregnancy and delivery in a cohort of female childhood cancer survivors treated with anthracyclines. Eur J Cancer 2006; 42: 2549–53.van Dalen EC, van der Pal HJ, van den Bos C, et al. Clinical heart failure during pregnancy and delivery in a cohort of female childhood cancer survivors treated with anthracyclines. Eur J Cancer 2006; 42: 2549–53.2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology. Eur Heart J 2016; 37: 2768–2801.2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology. Eur Heart J 2016; 37: 2768–2801.Nellessen U, Zingel M, Hecker H, et al. Effects of radiation therapy on myocardial cell integrity and pump function: which role for cardiac biomarkers? Chemotherapy 2010; 56: 147–52.Nellessen U, Zingel M, Hecker H, et al. Effects of radiation therapy on myocardial cell integrity and pump function: which role for cardiac biomarkers? Chemotherapy 2010; 56: 147–52.Larsen RL, Jakacki RI, Vetter VL et al. Electrocardiographic changes and arrhythmias after cancer therapy in children and young adults. Am J Cardiol 1992; 70: 73–7.Larsen RL, Jakacki RI, Vetter VL et al. Electrocardiographic changes and arrhythmias after cancer therapy in children and young adults. Am J Cardiol 1992; 70: 73–7.Yu, Anthony F. et al. Assessment of Early Radiation-Induced Changes in Left Ventricular Function by Myocardial Strain Imaging After Breast Radiation Therapy. J Am Soc Echocardiogr 2019; 32 (4): 521–528.Yu, Anthony F. et al. Assessment of Early Radiation-Induced Changes in Left Ventricular Function by Myocardial Strain Imaging After Breast Radiation Therapy. J Am Soc Echocardiogr 2019; 32 (4): 521–528.Hancock SL, Tucker MA, Hoppe RT. Factors affecting late mortality from heart disease after treatment of Hodgkin’s disease. JAMA 1993; 270: 1949–1955.Hancock SL, Tucker MA, Hoppe RT. Factors affecting late mortality from heart disease after treatment of Hodgkin’s disease. JAMA 1993; 270: 1949–1955.Prosnitz RG, Chen YH, Marks LB. Cardiac toxicity following thoracic radiation. Semin Oncol 2005; 32 (2 Suppl 3): S 71–S 80.Prosnitz RG, Chen YH, Marks LB. Cardiac toxicity following thoracic radiation. Semin Oncol 2005; 32 (2 Suppl 3): S 71–S 80.Louwe RJ, Wendling M, van Herk MB, et al. Three-dimensional heart dose reconstruction to estimate normal tissue complication probability after breast irradiation using portal dosimetry. Med Phys 2007; 34: 1354–1363.Louwe RJ, Wendling M, van Herk MB, et al. Three-dimensional heart dose reconstruction to estimate normal tissue complication probability after breast irradiation using portal dosimetry. Med Phys 2007; 34: 1354–1363.Bruzzaniti V, Abate A, Pinnaro P, et al. Dosimetric and clinical advantages of deep inspiration breathhold (DIBH) during radiotherapy of breast cancer. J Exp Clin Cancer Res 2013; 32: 88.Bruzzaniti V, Abate A, Pinnaro P, et al. Dosimetric and clinical advantages of deep inspiration breathhold (DIBH) during radiotherapy of breast cancer. J Exp Clin Cancer Res 2013; 32: 88.Xu Q, Chen Y, Grimm J, et al. Dosimetric investigation of accelerated partial breast irradiation (APBI) using CyberKnife. Med Phys 2012; 39: 6621–6628.Xu Q, Chen Y, Grimm J, et al. Dosimetric investigation of accelerated partial breast irradiation (APBI) using CyberKnife. Med Phys 2012; 39: 6621–6628.Reed GW, Masri A, Griffin BP, et al. Long-term mortality in patients with radiation-associated coronary artery disease treated with percutaneous coronary intervention. Circ Cardiovasc Interv 2016; 9.Reed GW, Masri A, Griffin BP, et al. Long-term mortality in patients with radiation-associated coronary artery disease treated with percutaneous coronary intervention. Circ Cardiovasc Interv 2016; 9.Desai M. Radiation associated valvular disease. JACC 2017. www.acc.org/latest-in-cardiology/articles/2017/06/13/07/13/radiation-associated-cardiac-disease.Desai M. Radiation associated valvular disease. JACC 2017. www.acc.org/latest-in-cardiology/articles/2017/06/13/07/13/radiation-associated-cardiac-disease.Wu W, Masri A, Popovic ZB, et al. Long-term survival of patients with radiation heart disease undergoing cardiac surgery: a cohort study. Circulation 2013; 127: 1476–85.Wu W, Masri A, Popovic ZB, et al. Long-term survival of patients with radiation heart disease undergoing cardiac surgery: a cohort study. Circulation 2013; 127: 1476–85.George TJ, Arnaoutakis GJ, Beaty CA, et al. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. An Thorac Surg 2012; 94: 445–51.George TJ, Arnaoutakis GJ, Beaty CA, et al. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. An Thorac Surg 2012; 94: 445–51.

The authors declare that there are no conflicts of interest present.