放疗对心律失常影响的机理认识和知识差距。

IF 6.4 1区 医学 Q1 ONCOLOGY
Poornima Balaji, Xingzhou Liulu, Sonaali Sivakumar, James J H Chong, Eddy Kizana, Jamie I Vandenberg, Adam P Hill, Eric Hau, Pierre C Qian
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引用次数: 0

摘要

立体定向体放射治疗(SBRT)是治疗难治性室性心律失常(VA)的一种创新模式。I/II期临床试验证明,SBRT在减少患者室性心律失常负荷(减少>85%)方面疗效显著,且具有良好的短期安全性。SBRT作为一种可选的VA治疗方法,可在门诊15-30分钟的治疗过程中,对不卧床、无镇静的患者进行单次分次治疗,且不会增加麻醉或手术的风险,这在临床上具有重要意义。然而,其基本机制仍不清楚。目前临床上使用的 SBRT 剂量源自旨在诱导心房跨壁纤维化的临床前研究。SBRT 的临床效应早于纤维化的时间进程。本综述探讨了辐射改变心肌细胞和心肌传导的电生理特性以产生抗心律失常效应的合理机制,以阐明临床观察结果,并为这一前景广阔的领域的进一步研究指明方向。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mechanistic Insights and Knowledge Gaps in the Effects of Radiation Therapy on Cardiac Arrhythmias.

Stereotactic body radiation therapy (SBRT) is an innovative modality for the treatment of refractory ventricular arrhythmias (VAs). Phase 1/2 clinical trials have demonstrated the remarkable efficacy of SBRT at reducing VA burden (by >85%) in patients with good short-term safety. SBRT as an option for VA treatment delivered in an ambulatory nonsedated patient in a single fraction during an outpatient session of 15 to 30 minutes, without added risks of anesthetic or surgery, is clinically relevant. However, the underlying mechanism remains unclear. Currently, the clinical dosing of SBRT has been derived from preclinical studies aimed at inducing transmural fibrosis in the atria. The propitious clinical effects of SBRT appear earlier than the time course for fibrosis. This review addresses the plausible mechanisms by which radiation alters the electrophysiological properties of myocytes and myocardial conduction to impart an antiarrhythmic effect, elucidate clinical observations, and point the direction for further research in this promising area.

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来源期刊
CiteScore
11.00
自引率
7.10%
发文量
2538
审稿时长
6.6 weeks
期刊介绍: International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field. This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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