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<title>がん患者の心臓を守る！腫瘍循環器学Q＆A | 株式会社文光堂</title>


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<meta name="description" content="がん治療の進歩により，がん患者の生存率が大幅に改善され，さらに新しいがん治療法も次々と生み出されている一方で，がんサバイバーの心血管疾患による死亡や，がん治療による心毒性が話題となっている．これらの問題に取り組む新たな学際領域として「腫瘍循環器学(Onco-Cardiology/Cardio-Oncology)」が生まれた．本邦ではまだ数少ないエキスパートの先生方に主要なテーマをQ&amp;A方式で執筆し">

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		<h1 class="catchCopy">今知っておきたい！がん治療の心血管への影響とは？</h1>
		

		<h1 class="title titleWidth">がん患者の心臓を守る！腫瘍循環器学Q＆A<span class="version"></span></h1>
		

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					編集：伊藤　浩（岡山大学大学院医歯薬学総合研究科循環器内科学教授）
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					<span class="transparent">編集</span>　向井幹夫（大阪府立病院機構大阪国際がんセンター成人病ドック科主任部長）
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				<ul class="property"><li class="disc">B5判・160頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1943-4</li><li class="disc">2018年3月21日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">がん治療の進歩により，がん患者の生存率が大幅に改善され，さらに新しいがん治療法も次々と生み出されている一方で，がんサバイバーの心血管疾患による死亡や，がん治療による心毒性が話題となっている．これらの問題に取り組む新たな学際領域として「腫瘍循環器学(Onco-Cardiology/Cardio-Oncology)」が生まれた．本邦ではまだ数少ないエキスパートの先生方に主要なテーマをQ&A方式で執筆して頂き，1テーマ見開き2ページの簡潔なスタイルでまとめた．</section><section class="preface">序 文<br><br>　日本における死因のNo.1はがんである．現在，がん対策基本法が制定され，国を挙げてがんに取り組んでいる．また，がんに対する治療の進歩は目覚ましく，外科治療に加え，さまざまな分子標的薬による化学療法や新たな放射線療法が開発され，がん患者の生存率は大幅に改善された．もはやがんは決して恐れるべき病気ではないという認識も生まれてきた．その楽観的雰囲気に水を差す事態が全く予期しないところから出現してきた．がん患者あるいはがんサバイバーが少なからず循環器疾患で命を落としているという現実である．<br>　以前から，がんの化学療法や放射線療法には心血管疾患系の副作用があることが知られていたが，問題になることはなかった．近年，がん患者の生命予後が改善したことで，これらのがん治療に伴う心不全，動脈硬化などの血管疾患，不整脈，高血圧そして血栓塞栓症が問題になるようになってきた．ここに，腫瘍内科医，外科医あるいは放射線科医と循環器医ががん患者のために協力して取り組む必要性が生じ，学際的な分野である腫瘍循環器学（Onco-CardiologyあるいはCardio-Oncology）が生まれた．欧米ではいち早く腫瘍循環器学の重要性に気づき，腫瘍医と循環器医が協力してステートメントを作成し，がん患者の生命予後を改善する対策を打ち出してきている．しかしながら，我が国ではその動きは鈍く，がん患者の心血管疾患対策は遅れているのが現状である．<br>　本書はこのようながん患者およびがんサバイバーの心血管疾患を治療あるいは予防し，生命予後をさらに改善するために，腫瘍循環器学の実践的なテキストを作ることを目的として企画された．腫瘍学と循環器学，お互いの領域を理解し合うのは難しい上に，まだ多施設共同臨床試験によるエビデンスがほとんどない領域である．そのため，数少ない腫瘍循環器領域のエキスパートオピニオンに頼らざるを得ないところも多い．しかし，患者は待ってはくれない．本書を世に出すことにより，腫瘍医と循環器医の心理的垣根を取り払い，協力して現時点で最善の治療を施すことにより患者の予後とQOL の改善を得ることができれば幸いである．これが執筆者一同の思いである．<br><br>2018年2月<br>伊藤　浩<br>向井幹夫</section><section class="indexes">Part １　腫瘍循環器とは<br>　Q1 腫瘍循環器（Onco-CardiologyあるいはCardio-Oncology）とはどういうものでしょうか？<br>　Q2 腫瘍循環器外来とはどのようなものでしょうか？ その役割を教えてください<br>　Q3 最近のがん治療の進歩により，がん患者の生命予後はどの程度改善されたのでしょうか？<br>　Q4 がん治療における心血管副作用にはどのようなものがあるか教えてください<br>　Q5 放射線治療による心血管合併症について教えてください<br>　Q6 腫瘍循環器医と腫瘍医の協力体制をどのように構築すべきか教えてください<br>　Q7 がんサバイバーの定義とその長期予後に対する心血管疾患の影響を教えてください<br>　Q8 成人になった小児がん患者の心血管リスクについて教えてください<br>　Q9 高齢がん患者へのがん治療における心血管合併症について教えてください<br>　Q10 欧米におけるOnco-Cardiologyへの取り組みを教えてください<br>Part ２　がん治療に伴う心毒性<br>2‒1 心毒性の診断<br>　Q11 心毒性（心血管合併症）はどのように分類されますか？どの治療で心毒性が出現するのでしょうか？<br>　Q12 Cancer therapeutics-related cardiac dysfunction（CTRCD）はどのようなものでしょうか？その臨床的意義を教えてください<br>　Q13 がん治療前にするべき循環器検査があれば教えてください<br>　Q14 がん治療による心毒性をどのように診断したらよいのでしょうか？：バイオマーカー，心電図<br>　Q15 がん治療による心毒性をどのように診断したらよいのでしょうか？：画像診断<br>2‒2 がん治療と心機能障害／心不全<br>　Q16 アントラサイクリン系薬はどのようなものでしょうか？作用機序，適応となるがんについて教えてください<br>　Q17 アントラサイクリン系薬による心不全の頻度と特徴，ハイリスク患者について教えてください<br>　Q18 アントラサイクリン系薬による心毒性のメカニズムを教えてください<br>　Q19 HER2阻害薬はどのようなものでしょうか？ また，適応となるがんについて教えてください<br>　Q20 HER2阻害薬による心毒性の特徴と頻度，そしてその機序を教えてください<br>　Q21 抗VEGF薬はどのようなものでしょうか？また，適応となるがんについて教えてください<br>　Q22 抗VEGF薬による心毒性の特徴と頻度，そしてその機序を教えてください<br>　Q23 チロシンキナーゼ阻害薬はどのようなものでしょうか？また，適応となるがんについて教えてください<br>　Q24 チロシンキナーゼ阻害薬による心毒性の特徴と頻度，そしてその機序を教えてください<br>　Q25 プロテアソーム阻害薬の作用機序，適応となるがんとその心毒性について教えてください<br>　Q26 免疫チェックポイント阻害薬（抗PD-1抗体）の作用機序，適応となるがんとその心毒性について教えてください<br>　Q27 胸部への放射線療法による心機能障害と弁膜症，そして心膜炎について教えてください<br>　Q28 抗がん剤による心毒性が認められたら，どのように対処したらよいでしょうか？<br>　Q29 抗がん剤の心毒性に対する予防法があれば教えてください<br>　Q30 抗がん剤には晩発性心筋障害もあると聞きました．慢性期の心機能チェックと治療はどのようにすればよいでしょうか？<br>2‒3 がん治療と血管障害<br>　Q31 がん治療が動脈硬化を促進し，心血管イベントを増加させることがあるのでしょうか？<br>　Q32 抗がん剤（フルオロピリミジン，シスプラチン，抗VEGF薬）による血管障害とその機序を教えてください<br>　Q33 がん治療に伴う血管障害や冠動脈疾患を診断する方法について教えてください<br>　Q34 抗がん剤による高血圧はどのように起こるのでしょうか？注意すべき薬剤とその機序について教えてください<br>　Q35 抗がん剤による高血圧の薬物治療について教えてください<br>　Q36 抗がん剤による腎機能障害はどのように起こるのでしょうか？注意すべき薬剤とその機序について教えてください<br>　Q37 がんあるいは抗がん剤による肺高血圧症について教えてください<br>　Q38 どのような患者で冠動脈イベントや血管障害に気をつけなければいけないのでしょうか？<br>　Q39 がん患者の冠動脈疾患の治療と予防，そして注意点を教えてください<br>　Q40 胸部への放射線療法により惹起される冠動脈疾患に特徴はありますか？その対策を教えてください<br>2‒4 がん治療と不整脈<br>　Q41 抗がん剤に関連する不整脈について教えてください<br>　Q42 抗がん剤によるQT延長とその臨床的意義を教えてください<br>　Q43 がん患者には心房細動が多いと聞きました．本当でしょうか？<br>　Q44 がん患者の心房細動に対して抗凝固療法をどのようにしたらよいでしょうか？<br>Part ３　クローズアップされるがん関連血栓塞栓症<br>　Q45 がん関連血栓塞栓症（CAT）の機序について教えてください<br>　Q46 がん患者の動脈血栓塞栓症の頻度とその機序について教えてください<br>　Q47 がん患者の静脈血栓塞栓症（VTE）とその臨床的重要性について教えてください<br>　Q48 どのようながん患者がVTEのハイリスクなのでしょうか？その予測スコアについても教えてください<br>　Q49 がんの術後合併症としてのVTEの頻度，意義とハイリスクな患者像を教えてください<br>　Q50 VTEの診断について，どのような症例にどのような検査を施行したらよいのか教えてください<br>　Q51 免疫調節薬（サリドマイド，レナリドミド）の作用機序，適応となるがんとその心毒性について教えてください<br>　Q52 VTEを合併しやすい抗がん剤について教えてください<br>　Q53 がん患者のVTEそして肺動脈血栓塞栓症の急性期治療について教えてください<br>　Q54 がん患者のVTEの慢性期治療について教えてください：ワルファリンvs低分子ヘパリン<br>　Q55 がん患者のVTEに対してDOACの有効性は証明されているのでしょうか？<br>　Q56 がん患者のVTEに対して抗凝固療法はいつまで続けたらよいのでしょうか？そしてどのようにフォローしていけばよいのでしょうか？ <br>　Q57 特にVTE再発リスクの高い病態について教えてください<br>Part ４　心臓とがん<br>　Q58 原発性心臓腫瘍とその診断，治療について教えてください<br>　Q59 転移性心臓腫瘍はどのようなものが多いのか教えてください<br>　Q60 がん性心膜炎，心タンポナーデの対策について教えてください<br>　Q61 ALアミロイドーシスの心不全について病態と治療を教えてください<br>索　引</section></article>
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