Cardiovascular Disease Amongst Women Treated for Breast Cancer: Traditional Cytotoxic Chemotherapy, Targeted Therapy, and Radiation Therapy

Chen, Daniel H.; Tyebally, Sara; Malloupas, Michael; Roylance, Rebecca; Spurrell, Emma; Raja, Fharat; Ghosh, Ashoke Kumar

doi:10.1007/s11886-021-01446-x

Cited by 12 publications

(11 citation statements)

References 55 publications

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“…Much effort has been made with newer technologies to reduce the total therapeutic dose needed and reduce the heart volume irradiated. There is a linear increase in cardiac toxicity per Gray of radiation dose increase [ 28 ]. Prior 2D-based radiation therapy was replaced by more conformal approaches such as 3D conformal radiation treatment (RT)and proton beam therapy [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

Radiation Treatment Mechanisms of Cardiotoxicity: A Systematic Review

Siaravas

Katsouras

Sioka

2023

IJMS

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Radiotherapy may be used alone or in combination with chemotherapy for cancer treatment. There are many mechanisms of radiation treatment exposure to toxicities. Our aim was to summarize the literature about known mechanisms of radiation-induced cardiac toxicities. We performed a systematic review of the literature on the PubMed database until October 2022 about cardiovascular toxicities and radiation therapy exposure. Only systematic reviews, meta-analyses, and reviews were selected. Out of 1429 publications screened, 43 papers met inclusion criteria and were selected for the umbrella review process. Microvascular and macrovascular complications could lead to adverse cardiac effects. Many radiotherapy-associated risk factors were responsible, such as the site of radiation treatment, beam proximity to heart tissues, total dosage, the number of radiotherapy sessions, adjuvant chemotherapeutic agents used, and patient traditional cardiovascular risk factors, patient age, and gender. Moreover, important dosage cutoff values could increase the incidence of cardiac toxicities. Finally, the time from radiation exposure to cardiac side effects was assessed. Our report highlighted mechanisms, radiation dosage values, and the timeline of cardiovascular toxicities after radiation therapy. All of the above may be used for the assessment of cardiovascular risk factors and the development of screening programs for cancer patients.

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Section: Resultsmentioning

confidence: 99%

Radiation Treatment Mechanisms of Cardiotoxicity: A Systematic Review

Siaravas

Katsouras

Sioka

2023

IJMS

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“…Firstly, it is important to notify that cardiotoxicity is not solely generated by radiation during BC treatment. Many studies in the field of cardio-oncology use the term ‘treatment-induced cardiotoxicity’ ( 49 – 51 ). Therefore, it could be considered a narrow approach to isolate radiotherapy from other cardiotoxic treatment factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

Quantifying Societal Burden of Radiation-Induced Cardiovascular Events in Breast Cancer Survivors

et al. 2022

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Background and PurposeRadiation-induced cardiotoxicity is an important health concern for clinicians during treatment of breast cancer (BC) patients. Underlying mechanisms are well-documented, whereas little is known about the societal impact of this long-term effect. This study aimed to quantify the additional burden of radiation-induced cardiovascular (CV) diseases in BC survivors.Materials and MethodsConventional health economic modelling techniques were applied to estimate attributed CV-related costs and disutility in a hypothetical cohort of BC survivors. A situation in which radiotherapy caused an additional CV risk was compared with a situation in which this risk was not taken into account. Uncertainty was assessed via deterministic and probabilistic sensitivity analyses. Analyses were performed from a broad societal perspective up until 20 years after BC treatment.ResultsRadiation-induced cardiotoxicity evokes a mean incremental cost of €275.10 per woman over a time horizon of 20 years after BC treatment. An additional decrement of 0.017 QALYs (per woman) might be expected when taking the radiation-induced cardiotoxic risk into account in BC survivors. Incremental costs and disutility increased with age. A scenario analysis showed that these results were more profound in women with more advanced staging.ConclusionOur analyses suggest that with current radiation techniques, rather minor costs and disutility are to be expected from radiation-induced cardiotoxicity in BC survivors. The cost of past investments in order to achieve current mean heart dose (MHD) seems justified when considering the gains from cost and disutility reduction resulting from radiation-induced cardiovascular events. The question we might consider is whether future opportunity costs associated with investments on further technological advancements offset the expected marginal benefit from further reducing the MHD.

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“…Collectively, in breast cancer patients, single agent targeted therapies can result in various toxicities, including cardiovascular ( 246 , 247 ), endocrine, dermatologic, and pulmonary toxicities ( 248 ). While advancements in the delivery of radiotherapy as a monotherapy have allowed for the precise delivery of radiation rays directly to cancerous lesions, radiotherapy can also damage nearby, non-malignant cells, resulting in acute and late-onset toxicities ( 249 ).…”

Section: Introductionmentioning

confidence: 99%

Updates in combined approaches of radiotherapy and immune checkpoint inhibitors for the treatment of breast cancer

et al. 2022

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Breast cancer is the most prevalent non-skin cancer diagnosed in females and developing novel therapeutic strategies to improve patient outcomes is crucial. The immune system plays an integral role in the body’s response to breast cancer and modulating this immune response through immunotherapy is a promising therapeutic option. Although immune checkpoint inhibitors were recently approved for the treatment of breast cancer patients, not all patients respond to immune checkpoint inhibitors as a monotherapy, highlighting the need to better understand the biology underlying patient response. Additionally, as radiotherapy is a critical component of breast cancer treatment, understanding the interplay of radiation and immune checkpoint inhibitors will be vital as recent studies suggest that combined therapies may induce synergistic effects in preclinical models of breast cancer. This review will discuss the mechanisms supporting combined approaches with radiotherapy and immune checkpoint inhibitors for the treatment of breast cancer. Moreover, this review will analyze the current clinical trials examining combined approaches of radiotherapy, immunotherapy, chemotherapy, and targeted therapy. Finally, this review will evaluate data regarding treatment tolerance and potential biomarkers for these emerging therapies aimed at improving breast cancer outcomes.

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Cardiovascular Disease Amongst Women Treated for Breast Cancer: Traditional Cytotoxic Chemotherapy, Targeted Therapy, and Radiation Therapy

Cited by 12 publications

References 55 publications

Radiation Treatment Mechanisms of Cardiotoxicity: A Systematic Review

Radiation Treatment Mechanisms of Cardiotoxicity: A Systematic Review

Quantifying Societal Burden of Radiation-Induced Cardiovascular Events in Breast Cancer Survivors

Updates in combined approaches of radiotherapy and immune checkpoint inhibitors for the treatment of breast cancer

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