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目的 探讨胸部肿瘤放疗中发生心脏性猝死的问题。我院放疗科自1992年7月到1996年6月间共收治放疗病人3008例,其中胸部肿瘤(食管癌、肺癌、纵隔肿瘤)计1501例。在放疗疗程中发生心脏性猝死6例。男女各3例,平均年龄65岁。其中中下段食管鳞癌3例,左下肺鳞癌3例。方法 放射治疗采用6MV-X体外照射,2Gy/次,5次/周的常规分割放疗。食管癌为前后对穿野加两后斜野,肺癌为纵隔加原发灶前后对穿照射,后缩野避开脊髓针对原发灶加量。结果 心脏受照射的胸部肿瘤病人疗程中猝死发生率为0.4％(6/1501)。6例病人猝死时放射治疗的肿瘤剂量平均为52Gy,心脏受照射面积平均为62％。而心脏未受照射的非胸部肿瘤病人疗程中无猝死发生。结论 胸部肿瘤病人的放射治疗可诱发心脏性猝死,特别是当心脏受照射剂量大于40Gy,心脏受照射面积大于60％时。
Objective To investigate the problem of sudden cardiac death in radiotherapy of thoracic tumors. In our radiology department, there were 3,008 patients undergoing radiotherapy from July 1992 to June 1996, including 1501 cases of breast cancer (esophageal cancer, lung cancer, and mediastinal tumor). Six sudden cardiac deaths occurred during radiotherapy. There were 3 men and 3 women, with an average age of 65 years. Among them, there were 3 cases of middle and lower esophageal squamous cell carcinoma and 3 cases of left lower squamous cell carcinoma. Methods Radiotherapy was performed with 6MV-X in vitro irradiation, 2Gy/time, 5 times/week routine fractionated radiotherapy. Before and after the esophageal cancer, the wild field plus two oblique fields were used. The lung cancer was the mediastinal plus the primary tumor before and after the irradiation, and the posterior contraction field avoided the spinal cord to increase the primary tumor volume. RESULTS: The incidence of sudden death was 0.4% (6/1501) in patients with heart-threatening thoracic tumors. The average tumor dose for radiation therapy for 6 patients was 52 Gy, and the average area of the heart was 62%. However, no sudden death occurred during the course of treatment of non-thoracic tumor patients whose hearts were not irradiated. Conclusion Radiotherapy for patients with thoracic tumors can induce sudden cardiac death, especially when the dose to the heart is greater than 40 Gy and the area irradiated to the heart is greater than 60%.