An overview of radiation-induced heart disease

Abstract

Radiation therapy (RT) has dramatically improved cancer survival, leading to several inevitable complications. Unintentional irradiation of the heart can lead to radiation-induced heart disease (RIHD), including cardiomyopathy, pericarditis, coronary artery disease, valvular heart disease, and conduction system abnormalities. Furthermore, the development of RIHD is aggravated with the addition of chemotherapy. The screening, diagnosis, and follow-up for RIHD in patients who have undergone RT are described by the consensus guidelines from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). There is compelling evidence that chest RT can increase the risk of heart disease. Although the prevalence and severity of RIHD are likely to be reduced with modern RT techniques, the incidence of RIHD is expected to rise in cancer survivors who have been treated with old RT regimens. However, there remains a gap between guidelines and clinical practice. Currently, therapeutic modalities followed in the treatment of RIHD are similar to the non-irradiated population. Preventive measures mainly reduce the radiation dose and radiation volume of the heart. There is no concrete evidence to endorse the preventive role of statins, angiotensin-converting enzyme inhibitors, and antioxidants. This review summarizes the current evidence of RIHD subtypes and risk factors and suggests screening regimens, diagnosis, treatment, and preventive approaches.

Late Effects of Ionizing Radiation on the Ultrastructure of Hepatocytes and Activity of Lysosomal Enzymes in Mouse Liver Irradiated In Vivo

“…Despite technological advances, we are still not able to completely protect healthy tissue, which is still a limitation during radiation therapy. Thoracic radiation has been associated with a significantly increased risk of unintentional irradiation of the heart and induction of radiation-induced heart disease (RIHD) and dysfunction of the cardiovascular system [22]. Exposure of the heart during thoracic irradiation occurs especially during the treatment of breast and lung cancers, and mediastinal lymphomas.…”

Radiopaque and X‐ray‐Responsive Nanomedicine for Preventive Therapy of Radiation‐Induced Heart Disease

“…[ 5 ] Primary prevention of RIHD aims to avoid radiation exposure to normal tissue. [ 6 ] However, even with the appropriate and accurate orientation of radiotherapy, [ 7 ] the heart is inevitably exposed to radiation during radiotherapy, thus medication for long‐term reduction of oxidative stress and inhibition of oxidative stress‐mediated apoptosis and fibrosis in cardiomyocytes is essential. [ 8–11 ]…”

“…[5] Primary prevention of RIHD aims to avoid radiation exposure to normal tissue. [6] However, even with the appropriate and accurate orientation of radiotherapy, [7] the heart is inevitably DOI: 10.1002/smll.202303803 exposed to radiation during radiotherapy, thus medication for long-term reduction of oxidative stress and inhibition of oxidative stress-mediated apoptosis and fibrosis in cardiomyocytes is essential. [8][9][10][11] Unfortunately, the radiation protection and treatment strategy for RIHD is still facing several challenges, particularly to prevent overexposure.…”

“…[12,13] Antioxidant therapy after radiation is also important for the treatment of RIHD. [7] However, intravascular administration of small-molecule antioxidants, such as amifostine (AMI), [14,15] is associated with systemic side effects and the risk of affecting the metabolism of normal tissues, [15,16] therefore, controlled release antioxidant system in situ after radiation is desired.…”

Role and molecular mechanism of traditional Chinese medicine in preventing cardiotoxicity associated with chemoradiotherapy

“…However, chemoradiotherapy not only affects resting LVEF but also has a wide range of effects on the entire cardiovascular system, including direct effects on cardiac structure (e.g., fibrosis), diastolic function, cardiac conduction and arrhythmias, systemic and pulmonary vascular function and hemodynamics, hemostasis and thrombosis, and cardiac response to injury and stress ( 13 ). Statins, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and dexrazoxane are currently used clinically to prevent or reduce radiotherapy-related cardiotoxicity ( 14 – 21 ). However, these drugs do not significantly reduce the risk of cardiotoxicity; instead, they interfere with the antitumor properties and prognostic benefits of anthracyclines, increasing the incidence of secondary malignancies ( 11 , 14 , 18 ).…”