Abstract：
Cardiac risk mitigation is a major priority in improving outcomes for cancer survivors as advances in cancer screening and treatments continue to decrease cancer mortality. More than half of adult cancer patients will be treated with radiotherapy (RT); therefore it is crucial to develop a framework for how to assess and predict radiation-induced cardiac disease (RICD). Historically, RICD was modelled solely using whole heart metrics such as mean heart dose. However, data over the past decade has identified cardiac substructures which outperform whole heart metrics in predicting for significant cardiac events. Additionally, non-RT factors such as pre-existing cardiovascular risk factors and toxicity from other therapies contribute to risk of future cardiac events. In this review, we aim to discuss the current evidence and knowledge gaps in predicting RICD and provide a roadmap for the development of comprehensive models based on three interrelated components, (1) baseline CV risk assessment, (2) cardiac substructure radiation dosimetry linked with cardiac-specific outcomes and (3) novel biomarker development.
摘要：
随着癌症筛查和治疗的进步继续降低癌症死亡率，减轻心脏风险是改善癌症幸存者预后的主要优先事项。超过一半的成年癌症患者将接受放射治疗（RT）；因此，制定一个评估和预测辐射诱发的心脏病（RICD）的框架至关重要。历史上,仅使用整个心脏指标如平均心脏剂量对RICD进行建模。然而,过去十年的数据已经确定了在预测重大心脏事件方面优于整个心脏指标的心脏亚结构。此外,非RT因素,如预先存在的心血管危险因素和其他疗法的毒性,会导致未来心脏事件的风险.在这次审查中,我们的目标是讨论当前的证据和知识差距，在预测RICD，并提供一个路线图的基础上，综合模型的发展三个相互关联的组成部分，（1）基线CV风险评估，（2）心脏亚结构辐射剂量学与心脏特异性结果相关，（3）新型生物标志物的开发。
