Radiobiological models in prediction of radiation cardiotoxicity

Abstract

Coronary disease induced by previous radiotherapy is the most common cause of death among patients treated with radiotherapy for cancer. Risk factors that may affect the frequency and intensity of radiotherapy's cardiac toxicity are primarily the radiation dose and the volume of the heart exposed to radiation. The prolonged survival time of patients after radiotherapy, but also the intensive development of modern radiotherapy techniques results in the necessity of precise estimation of both tumor control probability, and the risk of normal tissue damage, thus the models describing the probability of complications in normal tissues have also been developed. The response from the cardiovascular system to high-dose radiation is known and associated with a pro-inflammatory response. However, the effect of low doses may be completely different because it induces an anti-inflammatory response. Also, there is no unambiguous answer to the question of whether RICD is a deterministic effect. Moreover, there is a lack of literature data on the use of known radiobiological models to assess the risk of cardiovascular complications. The models described are general and concerns any healthy tissue. Therefore, when planning treatment for patients, particular attention should be paid to the dose and area of the heart to be irradiated.

Impact of Dose Calculation Algorithms and Radiobiological Parameters on Prediction of Cardiopulmonary Complications in Left Breast Radiation Therapy

“…Consequently, in large organs, such as lungs and heart, the cutoff criterion considered by TPS may be insufficient for the entire volume of these organs. Therefore, increasing the distance from the edges of the radiation field decreases the accuracy of NTCP calculation [ 40 ].…”

Early Diagnosis of Chemotherapy-Linked Cardiotoxicity in Breast Cancer Patients Using Conventional Biomarker Panel: A Prospective Study Protocol

“…Analysis of these cases revealed that only one of the women was administered cardiac protectors, and three women received adjuvant radiation treatment before admission to chemotherapy. Breast cancer patients who have undergone even small-dose radiation, particularly left-sided exposure, are known to carry an increased risk of ischemic heart disease, which is proportional to the radiation dose [ 31 , 32 ]. In the present cohort study, we cannot exclude those who underwent radiation treatment before chemotherapy due to the relatively small number of eligible patients in a single-center setting.…”

Future Perspectives of Proton Therapy in Minimizing the Toxicity of Breast Cancer Radiotherapy

“…The current priority in radiotherapeutic treatment is the highest possible beam conformality and full coverage of the irradiated volume while maintaining healthy tissues around the irradiated area without any damage [ 9 ]. Currently, proton therapy is not considered as the standard care for patients with breast cancer [ 10 ].…”