Cardiotoxicity of radiation therapy for malignancy
- Lawrence B Marks, MD
Lawrence B Marks, MD
- Department of Radiation Oncology
- UNC Hospitals and University of North Carolina at Chapel Hill
- Louis S Constine, MD
Louis S Constine, MD
- Professor of Radiation Oncology and Pediatrics
- Vice Chair
- University of Rochester Medical Center
- M Jacob Adams, MD, MPH
M Jacob Adams, MD, MPH
- Assistant Professor
- University of Rochester School of Medicine and Dentistry
- Section Editors
- William J McKenna, MD
William J McKenna, MD
- Section Editor — Myopericardial Disease
- Professor of Cardiology
- University College, London
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
The use of radiation therapy (RT) has contributed to significant improvements in disease-specific survival for patients with early stage breast cancer, Hodgkin lymphoma (HL), and other malignancies involving the thoracic region. (See "Treatment of favorable prognosis early (stage I-II) classical Hodgkin lymphoma" and "Overview of the treatment of newly diagnosed, non-metastatic breast cancer".)
These successes with RT, used either alone or in combination with other modalities, resulted in large cohorts of cancer survivors, who are subject to late complications from treatment. Analyses have shown that the therapeutic benefits from RT may be offset to some extent by delayed effects on the heart, thereby reducing the benefits of RT.
Irradiation of a substantial volume of the heart to a sufficiently high dose can damage virtually any component of the heart, including the pericardium, myocardium, heart valves, coronary arteries, capillaries, and conducting system. Pericarditis is the typical acute manifestation of radiation injury, while chronic pericardial disease, coronary artery disease, cardiomyopathy, valvular disease, and conduction abnormalities can manifest years or decades after the original treatment. These complications can cause significant morbidity or mortality.
The data on the late cardiovascular toxicity of RT come primarily from survivors of breast cancer and HL, diseases in which RT is a frequent component of the initial management and in which survival is often prolonged. Similar effects may be present in other cancer survivors who receive thoracic RT, although data are more limited.
An awareness of the potential cardiotoxicity of RT led to the application of improved RT techniques that minimize irradiation to the heart. These contemporary techniques appear to have substantially decreased the incidence of delayed complications, although whether or not there still is some residual risk remains uncertain.
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- BREAST CANCER
- Initial evidence of cardiovascular toxicity
- Contemporary RT techniques
- - Randomized trials
- - Effect of radiation dose to the heart
- Surrogate endpoints of myocardial injury
- Breast cancer summary
- HODGKIN LYMPHOMA
- Incidence of cardiovascular disease and ischemic events
- Mortality from myocardial infarction
- Other manifestations
- - Cardiomyopathy and diastolic dysfunction
- - Valvular disease
- - Conduction defects and autonomic dysfunction
- Risk factors in HL
- PEDIATRIC PATIENTS
- ESOPHAGEAL CANCER
- LUNG CANCER