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Kardiale Spätfolgen nach Strahlentherapie und Chemotherapie

Late cardiac effects after radiotherapy and chemotherapy

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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Kardiale Schäden gehören zu den möglichen Spätfolgen einer Krebstherapie.

Ziel

Kardiale Folgen spezifischer Therapieansätze bei ausgewählten Erkrankungen im Erwachsenenalter werden beschrieben.

Material und Methoden

In einem Review werden neuere Studien und Übersichtsarbeiten vorgestellt.

Ergebnisse

Für Krebs bei Erwachsenen liegen aufgrund der günstigen Prognose die meisten Studien an Patienten mit Hodgkin-Lymphom sowie an Patientinnen mit frühem Brustkrebs vor. In einer aktuellen prospektiven Studie mit Hodgkin-Lymphom-Patienten fanden sich abhängig von der Herzdosis vermehrt kardiovaskuläre Ereignisse. Der Zusammenhang war linear und betrug 7,4 % zusätzliches relatives Risikos pro Gray mittlerer Herzdosis. Unabhängig von der Bestrahlung erhöhte eine anthrazyklinhaltige Chemotherapie die Wahrscheinlichkeit für eine Herzinsuffizienz um den Faktor 3. Bei Patientinnen mit Mammakarzinom zeigte eine aktuelle Studie zu kardialen Spätfolgen der 3‑D-konformalen Radiotherapie ein zusätzliches kardiales Risiko. Beobachtet wurde ein statistisch signifikanter linearer Anstieg von 16,5 % pro Gray mittlerer Herzdosis nach einem medianen Follow-up von 7,6 Jahren. Übereinstimmend zeigen Studien, dass bei Brustkrebspatientinnen mit einer Vorgeschichte ischämischer Herzkrankheiten die Rate kardialer Ereignisse nach Bestrahlung höher ist als bei Frauen ohne eine solche Anamnese. Außerdem ist die adjuvante Therapie mit Anthrazyklinen mit einem unabhängigen kardialen Risiko bei Brustkrebspatientinnen assoziiert, kann aber darüber hinaus auch die kardialen Effekte einer Radiotherapie verstärken.

Schlussfolgerung

Mögliche Einflüsse onkologischer Therapie auf die Herzgesundheit müssen in Planung und Nachsorge onkologischer Therapien berücksichtigt werden.

Abstract

Background

Cardiotoxicity is a possible late adverse effect of cancer therapy.

Aim

The cardiac effects of specific treatment approaches in selected adult cancer diseases are described.

Materials and methods

Recent published studies and reviews are presented.

Results

Most studies on cardiac disease in adult cancer patients were based on cohorts of patients with Hodgkin lymphoma and early-stage breast cancer, due to the favorable prognosis of these entities. In a prospective study with Hodgkin lymphoma patients, the risk of coronary heart disease increased linearly with increasing mean heart dose (excess relative risk per Gray: 7.4%). Independently of radiotherapy, treatment with anthracyclines increased the risk for coronary heart disease by a factor of 3. A current study on late cardiotoxicity of 3D conformal radiotherapy in breast cancer patients with a median follow-up of 7.6 years showed the cardiac risk to increase significantly and linearly by 16.5% per Gray of mean heart dose. Consistent with this, studies on late effects after radiotherapy in breast cancer patients show that a history of ischemic cardiac disease increases the risk of radiotherapy-associated coronary heart disease compared to women without such an anamnesis. Furthermore, adjuvant anthracycline-based chemotherapy is associated with an independent cardiac risk in breast cancer patients, but may also increase the cardiac effects of radiotherapy.

Conclusion

Possible late cardiac effects of oncological therapy should be considered during the planning of individual treatment approaches and during follow-up care.

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Authors and Affiliations

  1. Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Deutschland

    Hiltrud Merzenich, Daniel Wollschläger & Maria Blettner

  2. Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    Katrin Almstedt & Marcus Schmidt

  3. Klinik und Poliklinik für Radioonkologie und Strahlentherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    Heinz Schmidberger & Marcus Stockinger

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  1. Hiltrud Merzenich
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  2. Daniel Wollschläger
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  3. Katrin Almstedt
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  4. Marcus Schmidt
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Correspondence to Hiltrud Merzenich.

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H. Merzenich, D. Wollschläger, K. Almstedt, M. Schmidt, M. Blettner, H. Schmidberger und M. Stockinger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Merzenich, H., Wollschläger, D., Almstedt, K. et al. Kardiale Spätfolgen nach Strahlentherapie und Chemotherapie. Onkologe 24, 780–789 (2018). https://doi.org/10.1007/s00761-018-0420-1

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