Early Cardiac Effects of Contemporary Radiation Therapy in Patients With Breast Cancer

Clasen, Suparna C.; Shou, Haochang; Freedman, Gary M.; Plastaras, John P.; Taunk, Neil K.; Teo, Boon-Keng; Smith, Amanda M.; Demissei, Biniyam G.; Ky, Bonnie

doi:10.1016/j.ijrobp.2020.12.008

Cited by 11 publications

(6 citation statements)

References 34 publications

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“…[12][13][14][15] Trastuzumab was shown to have cardiac side effects, which include a decline in LVEF and rarely CHF [7][8][9][10]29 ; however, this cardiotoxicity is generally reversible. 29,30 In addition, RT was shown to have a cardiotoxicity profile [16][17][18][19][20] by 2 different mechanisms: the first is by damaging the myocardial tissue leading to a decline in LVEF, 21 and the second mechanism is by direct damage to the coronary vessels leading to ischemic heart disease (CVE in the current study). 16 Modern techniques in RT, like DIBH and proton therapy, resulted in a decreased radiation dose to the heart and reduced cardiotoxicity in patients receiving chest radiation.…”

Section: Discussionmentioning

confidence: 60%

“…[16][17][18][19][20] RT for breast cancer (especially left sided) was shown to increase the incidence of ischemic heart disease due to damage to the coronary vessels, 16 and a modest decline in the LVEF due to damage to the myocardium. 21 To minimize cardiac side effects of RT, modern techniques have been developed to limit the dose to the heart during chest irradiation. 22 One such technique is deep inspirational breath holding (DIBH).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Cardiotoxicity in HER-2-Positive Breast Cancer Patients Treated With Radiation Therapy and Trastuzumab

Bachir

Anouti

Jaoude

et al. 2022

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Evaluation of Cardiotoxicity in HER-2-Positive Breast Cancer Patients Treated With Radiation Therapy and Trastuzumab

Bachir

Anouti

Jaoude

et al. 2022

International Journal of Radiation Oncology*Biology*Physics

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“…Radiation doses above 30 Gy reportedly increased RIHD by three and a half folds [18,56]. Some of the studies about radiation-related risk factors are summarized in Table 1 [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64].…”

Section: Radiation-related Risk Factorsmentioning

confidence: 99%

“…Morris et al [60] Deep learning poses extensive efficiency and accuracy gains for cardiac substructure segmentation, offering the increased potential for rapid implementation into radiation therapy planning for improved cardiac sparing. Clasen et al [61] Modest subclinical changes in cardiac function measures were seen in the short term with use of modern radiation planning techniques. Atkins et al [62] Cardiac radiation dose exposure is a cardiac risk factor for major adverse cardiac events and all-cause mortality in advanced NSCLC.…”

Section: Studymentioning

confidence: 99%

An overview of radiation-induced heart disease

et al. 2022

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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.

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“…Although advances in modern radiation technology have reduced the incidence of cardiotoxicity, current evidence demonstrates that the risk of cardiotoxicity remains (21). Therefore, greater knowledge of risk factors for radiation-induced cardiotoxicity is needed.…”

Section: Introductionmentioning

confidence: 99%

Correlation of Mean Heart Dose and Cardiac Biomarkers with Electrocardiographic Changes in Patients Receiving Thoracic Radiation Therapy

et al. 2023

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Cardiotoxicity is a well-recognized, serious adverse effect of thoracic radiation therapy. This study aimed to evaluate longitudinal electrocardiogram (ECG) changes in patients receiving thoracic radiation therapy and identify correlating factors that can predict the risk of cardiotoxicity. This retrospective study included 202 patients treated with thoracic radiation therapy, and chemotherapy and targeted therapy were allowed. Mean heart dose (MHD) was evaluated on dose-volume histograms. ECG, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal B-type natriuretic peptide (NT-proBNP) analyses were conducted before irradiation and during the follow-up period of 6–12 months (average 8 months). Chi square test and logistic regression analysis were applied to identify risk factors associated with ECG changes. At a median time of 3 months postirradiation, 46.5% of patients showed ECG changes, and 33.0% of patients achieved baseline ECG levels during the follow-up period at a median of 5 months postirradiation. Logistic regression analysis identified MHD, hs-cTnT and NT-pro BNP as significant factors associated with ECG changes (P < 0.05). Hs-cTnT and NT-proBNP were increased significantly after radiation therapy compared with baseline levels (P < 0.05), and these increases were observed as a median time of 2 months postirradiation, which was earlier than ECG changes. Higher MHD and elevated hs-cTnT and NT-proBNP levels correlated with an increased risk of ECG changes in patients receiving thoracic radiation therapy. Early identification of patients at high risk of cardiotoxicity and timely intervention might reduce the incidence of radiation-induced cardiac toxicity.

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Early Cardiac Effects of Contemporary Radiation Therapy in Patients With Breast Cancer

Cited by 11 publications

References 34 publications

Evaluation of Cardiotoxicity in HER-2-Positive Breast Cancer Patients Treated With Radiation Therapy and Trastuzumab

Evaluation of Cardiotoxicity in HER-2-Positive Breast Cancer Patients Treated With Radiation Therapy and Trastuzumab

An overview of radiation-induced heart disease

Correlation of Mean Heart Dose and Cardiac Biomarkers with Electrocardiographic Changes in Patients Receiving Thoracic Radiation Therapy

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