Cardiac Complications of Thoracic Irradiation

Abstract

Adjuvant radiation therapy in the management of early stage breast cancer, Hodgkin's disease, and to a lesser extent other thoracic malignancies has led to a significant improvement in disease-specific survival. Cardiovascular disease is now the most common nonmalignancy cause of death in radiation-treated cancer survivors, most often occurring decades after treatment. The spectrum of radiation-induced cardiac disease is broad, potentially involving any component of the heart. The relative risk of coronary artery disease, congestive heart failure, valvular heart disease, pericardial disease, conduction abnormalities, and sudden cardiac death is particularly increased. Over the years contemporary techniques have been introduced to reduce cardiac morbidity and mortality in radiation-treated cancer survivors; however, the long-term effects on the heart still remain unclear, mandating longer follow-up. Awareness and early identification of potential cardiac complications is crucial in cancer survivors, with the management often being quite complex. This review examines the epidemiology of radiation-induced cardiac disease together with its pathophysiology and explores the available treatment strategies and the potential utility of various screening strategies for affected cancer survivors.

Constrictive Pericarditis 5 Months after Radiation Therapy in a 62-Year-Old Woman with Esophageal Cancer

“…Computed tomography can be used to evaluate calcification in the pericardium. 25 Our patient did not undergo surgery or a biopsy. In the other patients, 5,9,10 histologic findings suggested thick, fibrous pericardium-the same as in cancer survivors when chronic radiation-induced inflammation leads to fibrotic fusion and thickening of the visceral and parietal pericardium, whether associated with effusion or not.…”

“…After RT for different thoracic malignancies, the incidence of cardiac sequelae (including pericardial toxicities) increases significantly when the total radiation dose exceeds 30 Gy. 12,25 Similarly, CP is possibly a marker for greater radiation injury to the heart. 25 In the past, right-sided heart catheterization was usually needed to confirm the diagnosis of CP.…”

“…12,25 Similarly, CP is possibly a marker for greater radiation injury to the heart. 25 In the past, right-sided heart catheterization was usually needed to confirm the diagnosis of CP. Our patient's diagnosis was made early, with use of echocardiography and CMR-methods that enable anatomic, physiologic, and hemodynamic evaluation of the heart and associated structures.…”

“…In the other patients, 5,9,10 histologic findings suggested thick, fibrous pericardium-the same as in cancer survivors when chronic radiation-induced inflammation leads to fibrotic fusion and thickening of the visceral and parietal pericardium, whether associated with effusion or not. 25,26 Treatment recommendations for radiation-induced CP continue to evolve; nevertheless, mortality rates remain high. Medical regimens and operative treatments have yielded varying outcomes.…”

From heart to heart for breast cancer patients—cardiovascular toxicities in breast cancer radiotherapy

“…F Those patients in whom either of the two dose/volume criteria exceed, will undergo a gated treatment planning by active breathing control. F For patients in whom either of the two dose/volume criteria will not be met or patients with preexistent risk factors (i.e., women with cardiac risk factors or which underwent cardiotoxic systemic therapy), a basic cardio logical evaluation and standardized follow-ups will be developed jointly with cardiologists [22] and according to the recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography [23].…”