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Cardiotoxicity of radiation therapy for breast cancer and other malignancies

Lawrence B Marks, MD
Louis S Constine, MD
M Jacob Adams, MD, MPH
Section Editors
William J McKenna, MD
Steven E Schild, MD
Deputy Editor
Sadhna R Vora, MD


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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Literature review current through: Sep 2017. | This topic last updated: Aug 09, 2017.
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