Radiation-associated cardiovascular disease: manifestations and management☆
Section snippets
Spectrum of cardiovascular complications
The spectrum of radiation-associated CVD is broad and includes direct and indirect effects Table 1, Table 2.
Screening and diagnosis
Although screening regimens have been suggested for patients treated with doxorubicin,50 no screening regimen for those treated with mediastinal radiotherapy and/or an anthracycline has ever been tested for efficacy and cost-effectiveness. Yet, the wide range of possible cardiac abnormalities associated with therapeutic chest irradiation suggests the potential usefulness of multiple screening modalities (Table 3). This section will discuss potentially useful screening tests for
Management
Prevention is the best way to treat radiation-associated cardiotoxicity. Modern irradiation techniques have clearly decreased the frequency of cardiac disease, although it does not appear that they have significantly decreased the most serious risk, the incidence of fatal myocardial infarction. Modern techniques include using a linear accelerator as a radiation source, a daily fraction size <2 Gy, equally weighted anterior/posterior portals each treated daily, and minimizing the volume of heart
References (74)
- et al.
Long-term complications of treatment and causes of mortality after Hodgkin’s disease
Semin Radiat Oncol
(1996) - et al.
The need for long-term surveillance for patients treated with curative radiotherapy for Hodgkin’s diseaseUniversity of Minnesota experience
Int J Radiat Oncol Biol Phys
(2000) - et al.
Ischemic heart disease after mantlefield irradiation for Hodgkin’s disease in long-term follow-up
Radiother Oncol
(1999) - et al.
Radiation related chronic heart disease
Chest
(1983) - et al.
Mortality pattern over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy
Clin Radiol
(1989) - et al.
Long-term cardiac morbidity and mortality in a randomized trial of pre- and post-operative radiation therapy versus surgery alone in primary breast cancer
Radiother Oncol
(1998) - et al.
Mortality from myocardial infarction following postlumpectomy radiotherapy for breast cancerPopulation-based study in Ontario, Canada
Int J Radiat Oncol Biol Phys
(1999) - et al.
Cardiovascular disease in long-term survivors of pediatric Hodgkin’s disease
Prog Pediatr Cardiol
(1998) - et al.
Cardiac function, perfusion, and morbidity in irradiated long-term survivors of Hodgkin’s disease
Int J Radiat Oncol Biol Phys
(1997) - et al.
Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicinpreliminary results
Int J Radiat Oncol Biol Phys
(2001)
Myocardial damage in breast cancer patients treated with adjuvant radiotherapyA prospective study
Int J Radiat Oncol Biol Phys
Myocardial function in children and adolescents after therapy with anthracyclines and chest irradiation
Eur J Cancer
Radiation-associated valvular disease
Chest
Cardiac lesions after mediastinal radiation for Hodgkin’s disease
Radiother Oncol
Late cardiac effects after mantle radiation in patients with Hodgkin’s disease
Ann Oncol
No serious late cardiac effects after adjuvant radiotherapy following mastectomy in premenopausal women with early breast cancer
Int J Radiat Oncol Biol Phys
Electrocardiographic changes and arrhythmias after cancer therapy in children and young adults
Am J Cardiol
Associated cardiac lesions in patients with radiation-induced complete heart block
Int J Cardiol
Radiation-induced valvular dysfuction
J Am Coll Cardiol
Management of patients with radiation-induced pericarditis with effusionA note on the development of regurgitaion in two of them
Chest
Clinical and angiographic features of coronary artery disease after chest irradiation
Am J Card
Coronary artery operation in radiation-associated atherosclerosisLong-term follow-up
Ann Thorac Surg
Use of the internal mammary artery for myocardial revascularization in a patient with radiation-induced coronary artery disease
Mayo Clin Proc
Use of internal mammary artery in myocardial revascularization after mediastinal irradiation
J Thorac Cardiovasc Surg
Radiation-induced cardiovascular dysfunction
Am J Cardiol
Radiation injury to the heart
Int J Radiat Oncol Biol Phys
Pathology of radiation-induced heart diseaseA surgical and autopsy study of 27 cases
Hum Pathol
Radiation heart disease. Analysis of 16 young (aged 15-33 years) necropsy patients who received over 3,500 rads to the heart
Am J Med
Cardiac risk after mediastinal irradiation for Hodgkin’s disease
Radiother Oncol
Long-term survival in Hodgkin’s diseaseRelative impact of mortality, second tumors, infection and cardiovascular disease
Cancer J Sci Am
Factors affecting late mortality from heart disease after treatment for Hodgkin’s disease
JAMA
Cardiac disease following treatment of Hodgkin’s disease in children and adolescents
J Clin Oncol
Coronary artery disease mortality in patients treated for Hodgkin’s disease
Cancer
Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy
J Clin Oncol
Mortality from myocardial infarction after adjuvant radiotherapy for breast cancer in the surveillance, epidemiology, and end-results cancer registries
J Clin Oncol
Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancerAn overview of randomised trials
Lancet
Mortality by laterality of the primary tumor among 55, 000 breast cancer patients from the Swedish center registry
Br J Cancer
Cited by (191)
Cancer survivorship and comorbidity disease risk after cancer treatment
2022, Cardio-Oncology Practice Manual: A Companion to Braunwald's Heart DiseaseImaging of the Chest After Radiotherapy and Potential Pitfalls
2021, Seminars in Ultrasound, CT and MRICitation Excerpt :Many of these adverse effects are late and more commonly seen in long-term survivors irradiated to the mediastinum at a younger age.14 Factors associated with cardiac radiation damage include radiation dose (>30Gy), volume of irradiated heart, age at exposure (younger age) and patient and treatment specific factors including concurrent chemotherapy.15,16 Accelerated atherosclerosis is seen 10 to 30 years post exposure.17
Assessment of Prognostic Value of High-Sensitivity Cardiac Troponin T for Early Prediction of Chemoradiation Therapy-Induced Cardiotoxicity in Patients with Non-Small Cell Lung Cancer: A Secondary Analysis of a Prospective Randomized Trial
2021, International Journal of Radiation Oncology Biology Physics
- ☆
Supported by the National Institute of Cancer (CA-79060); National Heart, Lung, and Blood Institute (HL-53392), (5K30HL04161), Preventive Cardiology Training Grant (1T32HL07937) and Wilmot Cancer Research Fellowship of the James P. Wilmot Foundation.