Radiation-Related Heart Disease: Up-to-Date Developments

Abstract

Approximately 25-30% of patients with cancer undergo thoracic radiation therapy (RT). RT might inadvertently induce heart injury and result in various forms of radiationrelated heart disease (RRHD). The main endpoints of RRHD include cardiac death from RT, clinical heart disease (congestive heart disease, ischemic heart disease, and myocardial infarction), and subclinical heart disease (cardiac perfusion defects). Advanced RT techniques, such as breath control, intensity-modulated RT, and image-guided RT, as well as limited target volume definition might spare or avoid cardiac doses and/or volume, which may translate into decreased incidence of RRHD. The total delivered radiation dose to cardiac implantable electronic devices was strongly recommended not to exceed 2 Gy. The treatment strategies of RRHD were based on the various recommended consensus of related heart diseases in cardiology. However, the standardized definitions of the cardiac structures, dose-volume limits during radiation planning design, the optimal dose-volume parameters, and the dose-volume effects of various cardiac substructures warrant further investigation. The recognition, prediction, prevention, and management of RRHD require close collaboration between oncologists and cardiologists.

Magnetic Resonance Imaging Evaluation of Incidental Cardiac Irradiation During Left Breast Cancer Radiotherapy: A Systematic Review

“…Radiotherapy (RT) is currently administered to about 50% of the patients with malignant neoplasms (1). Approximately 25-30% of patients with malignant neoplasm undergo thoracic radiation therapy which have been proven to improve wellbeing and prolong patients' survival (1,2). Radiotherapy is one of the most principal methods for the treatment of cancerous tumours (3).…”

“…However, in the process of radiotherapy for the thoracic tumours such as breast cancer, esophageal cancer, lung cancer, and mediastinal lymphoma, the major organ located in the mediastinum which include the heart is affected inevitably by incidental irradiation (3). The irradiation resulted in cardiac injury/toxicity and various kinds of radiation-related cardiac disease (1,2). Although it was initially thought that cardiovascular system was somewhat resistant to damage induced by radiation, it was until 1930s, when evidence of cardiac injury arising from thoracic radiation exposure was observed to be accumulating (4).…”