王相涵,张 哲,刘素坤

三维适形放疗（3D-CRT）、调强放疗（IMRT/VMAT）、立体定向体部放疗（SBRT/SABR）以及质子治疗的推行，使非小细胞肺癌（NSCLC）患者的生存期明显延长。但随之而来的问题是，胸部放疗相关心脏损伤（radiation-induced heart disease,RIHD）正逐渐成为影响长期生存和生活品质的严重并发症。NRG/RTOG 0617等大型临床研究已经证实，心脏受照剂量——尤其是V30、V40、V50及平均心脏剂量（MHD）——与NSCLC患者总生存（OS）的下降存在独立相关关系[1,2]。近年来学界的研究重心发生了明显转移：从早期把全心脏当成一个危及器官的粗放模式，已经转向关注心脏亚结构剂量-反应关系，并借助AI自动勾画、呼吸门控/深吸气屏气（DIBH）、质子治疗等手段降低心脏暴露[3,6]。本文试围绕肺癌放疗相关心脏损伤的流行病学、病理机制、剂量学预测、预防技术以及临床管理的最新进展做一次系统梳理。

肺癌；放射治疗；放射性心脏损伤；心脏亚结构；剂量学；深吸气屏气；质子治疗；心肿瘤学

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