Radiotherapy is an essential part of treatment for many patients with thoracic cancers. However, proximity of the heart to tumour targets can lead to cardiac side effects, with studies demonstrating link between cardiac radiation dose and adverse outcomes. Although reducing cardiac dose can reduce associated risks, most cardiac constraint recommendations in clinical use are generally based on dose to the whole heart, as dose assessment at cardiac substructure levels on individual patients has been limited historically. Furthermore, estimation of an individual's cardiac risk is complex and multifactorial, which includes radiation dose alongside baseline risk factors, and the impact of systemic therapies. This review gives an overview of the epidemiological impact of cancer and cardiac disease, risk factors contributing to radiation‐related cardiotoxicity, the evidence for cardiac side effects and future directions in cardiotoxicity research. A better understanding of the interactions between risk factors, balancing treatment benefit versus toxicity and the ongoing management of cardiac risk is essential for optimal clinical care. The emerging field of cardio‐oncology is thus a multidisciplinary collaborative effort to enable better understanding of cardiac risks and outcomes for better‐informed patient management decisions.

中文翻译：

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放射治疗引起的心脏毒性概述


放射治疗是许多胸癌患者治疗的重要组成部分。然而，心脏与肿瘤靶点的接近可能会导致心脏副作用，研究表明心脏辐射剂量与不良后果之间存在联系。尽管减少心脏剂量可以降低相关风险，但临床使用中的大多数心脏约束建议通常基于整个心脏的剂量，因为历史上对个体患者的心脏亚结构水平的剂量评估受到限制。此外，对个人心脏风险的估计是复杂且多因素的，其中包括辐射剂量、基线风险因素以及全身治疗的影响。本综述概述了癌症和心脏病的流行病学影响、导致辐射相关心脏毒性的危险因素、心脏副作用的证据以及心脏毒性研究的未来方向。更好地了解风险因素之间的相互作用、平衡治疗益处与毒性以及心脏风险的持续管理对于最佳临床护理至关重要。因此，心脏肿瘤学的新兴领域是一个多学科协作的领域，旨在更好地了解心脏风险和结果，以便做出更明智的患者管理决策。