Breast Radiotherapy-Related Cardiotoxicity. When, How, Why. Risk Prevention and Control Strategies

Díaz-Gavela, Ana Aurora; Figueiras-Graillet, L.M.; Ángel, Luís; Segura, Juliana Salas; Ciérvide, R.; Peñalver, E. del Cerro; Couñago, Felipe; Arenas, Meritxell; López‐Fernández, Teresa

doi:10.3390/cancers13071712

Cited by 30 publications

(23 citation statements)

References 121 publications

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“…Rectal bleedings after dose-escalated treatment of prostate cancer by external beam radiotherapy and intestinal brachytherapy, the risk of late cardiac mortality for young patients treated with anthracyclines or anti-HER2 therapy, and radiotherapy for early-stage breast cancer are just a few situations that justify the need for an in-depth understanding of all aspects related to radiotherapy and radiobiology of tumors and healthy tissues. They illustrate the need for advanced educational approaches including all aspects involved in these phenomena [ 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: New Challenges and Trends With Impact On Radiation Oncology ...mentioning

confidence: 99%

Education in Radiation Oncology—Current Challenges and Difficulties

Mireștean

Iancu

2022

IJERPH

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The evolution and development of radiotherapy in the last two decades has meant that postgraduate medical training has not kept up with this rapid progress both in terms of multidisciplinary clinical approaches and especially in terms of technological advances. Education in radiation oncology is a major priority in the context of the rapid development of radiotherapy, including advanced knowledge of radiobiology, radiation physics and clinical oncology, anatomy, tumor biology and advanced medical imaging. In this context, the lack of training in radiation oncology in the curricula of medical faculties may have detrimental consequences for the training of residents in radiotherapy but also in their choice of specialty after completing their university studies. There is a clear gap between resident physicians’ actual and required knowledge of radiotherapy, and this requires urgent remediation. In the context of technical advances in imaging-guided radiotherapy (IGRT) and new radiobiology data, a balanced approach divided equally between general oncology, clinical radiation oncology, radiation oncology technology, medical physics and radiobiology, anatomy and multimodal imaging, including mentorship could bring educational and career choice benefits for students of radiation oncology.

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Section: New Challenges and Trends With Impact On Radiation Oncology ...mentioning

confidence: 99%

Education in Radiation Oncology—Current Challenges and Difficulties

Mireștean

Iancu

2022

IJERPH

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“…Improvements in RT planning have reduced the volume of the heart and major coronary vessels to be exposed to high doses. Advanced RT delivery modalities include prior computed tomography (CT)-guided field planning, threedimensional conformal radiotherapy (3D-CRT) intensitymodulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), proton therapy, and respiratory-gated radiotherapy in deep-inspiration breath-hold (DIBH) (77)(78)(79). In order to minimize heart doses over a course of RT, DIBH were developed for a more favorable position of the heart during inspiration (80).…”

Section: Protection Against Radiation-induced Cardiovascular Toxicitymentioning

confidence: 99%

The risk of cardiovascular toxicity caused by cancer radiotherapy—a narrative review

Liu¹,

Fu²,

Liu³

et al. 2022

Ther Radiol Oncol

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Background and Objective: Radiotherapy is an efficient treatment for cancer. However, some cancer survivors who receive thoracic radiotherapy experience radiation-induced cardiovascular toxicity, leading to long-term impact on cardiovascular health. This review summarizes the current literature regarding the basic pathogenic mechanisms, development, and prevention of radiation-induced cardiovascular toxicity.Methods: A literature search was performed on PubMed to find reported histological observations and studies on acute and late cardiovascular toxicity in cancer patients treated with radiotherapy. A systematized review of articles on the present topic published between May 1967 and April 2021 was carried out.

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“…Prevention or minimizing radiation induced heart and lung toxicity is one of the most important issues in breast cancer radiotherapy with the goal to reduce morbidity, bearing in mind that breast cancer patients are usually long-term cancer survivals [12,13]. In radiotherapy treatment planning, maximum and mean doses for organs at risk are important for predicting possibility of acute and late toxicity.…”

Section: Introductionmentioning

confidence: 99%

Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic

et al. 2022

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Background and Objectives: Reducing time of treatment during COVID-19 outbreaks has been recommended by the leading Radiation Oncology societies. Still minimizing radiation induced tissue toxicity is one of the most important issues in breast cancer patients. The study aimed to investigate compliance, clinical and dosimetry normal tissue toxicity, and cosmetic results between moderated and ultra-fractionated regimes for breast cancer patients during COVID-19 pandemic. Materials and Methods: This pilot prospective randomized study included 60 patients with early breast cancer after preserving surgery, 27 patients advocated to ultra-hypofractionated whole-breast three dimensional (3D) conformal radiotherapy of 26 Gy in 5 fractions over 1 week and 33 patients with moderate fractionated breast 3D conformal radiotherapy patients between March 2020 and July 2020, during the COVID pandemic outbreak. The compliance to treatment, dosimetric parameters, acute and late skin toxicity, subcutaneous tissue toxicity, cosmetic results and clinical follow up for 18 months for the two regimes were analyzed and compared. Results: When two regimes were compared 5 fraction group had significantly lower prevalence of newly infected cases of SARS-CoV-2 and thus delayed/interrupted treatment (p = 0.05), comparable grade 1 CTCAE v5, acute skin toxicity (p = 0.18), Grade 1 Radiation Morbidity Scoring Scheme (RESS) subcutaneous tissue toxicity (p = 0.18), Grade 1 RESS late skin toxicity (p = 0.88) and cosmetic results (p = 0.46). Dosimetric results reveled that patients in 5 fraction group received significantly lower median ipsilateral lung doses (p < 0.01) in addition to left breast cancer patients that received significantly lower median heart dose (p < 0.01) and median left anterior descending artery (LAD) dose (p < 0.01). Conclusion: Ultra-hypofractionated radiotherapy for breast cancer is comparable to moderate hypofractionation regimen regarding grade 1 acute skin toxicity, grade 1 subcutaneous tissue toxicity, late skin toxicity and cosmetic results. Application of ultra-hypofractionated radiotherapy with significantly lower radiation doses for lung and heart could be crucial in reducing the risk of acute/late pulmonary and heart radiation-induced toxicity.

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Breast Radiotherapy-Related Cardiotoxicity. When, How, Why. Risk Prevention and Control Strategies

Cited by 30 publications

References 121 publications

Education in Radiation Oncology—Current Challenges and Difficulties

Education in Radiation Oncology—Current Challenges and Difficulties

The risk of cardiovascular toxicity caused by cancer radiotherapy—a narrative review

Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic

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