Cardiovascular effects of radiotherapy on the patient with cancer

Abstract

Summary The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presentes a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals. Injuries caused by RT include diseases of the pericardium, coronary artery disease, valvular disease, myocardial disease with systolic and diastolic dysfunction, conduction disorders, and carotid artery and great vessels disease. Thoracic and cervical irradiation increases cardiovascular morbidity and mortality. Despite the great progress in the improvement of RT techniques, totally excluding prime areas of the cardiovascular system from the irradiation field is not yet possible. Guidelines must be created for monitoring, diagnosis and treatment of patients with CA treated with RT.

The Protective Effect of L-carnitine against Gamma Irradiation- Induced Cardiotoxicity in Male Albino Rats.

“…Radiation therapy (RT) is an important component of the therapeutic arsenal for the treatment of breast cancer, Hodgkin's disease, lung cancer and other tumors involving the cervical and thoracic regions and is linked to increased cardiovascular morbidity and mortality (Moreira et al, 2016). Which is proportional to the dose of radiation and the site exposed in the cardiovascular system (Daher et al, 2012) The cardiac effects of RT in the long term are heterogeneous and include coronary artery disease, valve disease; diseases of pericardium; myocardial diseases, with systolic and diastolic dysfunction in particular; and conduction system disturbances (Wu et al, 2013).…”

The Inverse Correlation Between the Duration of Lifetime Occupational Radiation Exposure and the Prevalence of Atrial Arrhythmia

“…Although they are not exposed to the direct X-ray beam, invasive cardiologists receive radiation from the scatter, which can vary extremely, ranging from 0.04 to 38 μSv per procedure ( 25 ). Over the course of an interventional cardiologist's career, he or she is exposed to 50–200 mSv of ionizing radiation, which is equivalent to 2,500–10,000 chest X-rays ( 9 , 12 , 14 , 15 , 26 ). Newer techniques focus on minimizing, or even eliminating radiation use but these protocols are not widespread ( 27 , 28 ).…”

Kardiotoksisitas Akibat Terapi Radiasi

“…15 Risiko penyakit jantung koroner baik penyakit jantung koroner yang stabil ataupun sindrom koroner akut dapat terjadi pada lima tahun pertama setelah radioterapi dan terus meningkat sekurangnya sampai 20 tahun. 15,16 Tidak terdapat perbedaan risiko yang bermakna antara pasien yang sebelumnya memiliki risiko penyakit jantung koroner dan yang tidak memiliki faktor risiko pada saat radioterapi. 15 Risiko terjadinya penyakit jantung koroner semakin meningkat bila pasien mendapat radiasi melebihi 30-35Gy.…”

“…15,16 Tidak terdapat perbedaan risiko yang bermakna antara pasien yang sebelumnya memiliki risiko penyakit jantung koroner dan yang tidak memiliki faktor risiko pada saat radioterapi. 15 Risiko terjadinya penyakit jantung koroner semakin meningkat bila pasien mendapat radiasi melebihi 30-35Gy. 16 Studi oleh Filopei, dkk.…”

“…2,18 Gambaran hitologis menunjukkan fibrosis difus pada seluruh lapisan luar dinding arteri, penebalan fibrointima, lesi fibroproliferatif, fibrokalsifikasi, kekurangan otot polos pada bagian media, dan beberapa deposit lemak atau plak fibrolipid. 2,15 Kerusakan mikrovaskuler memengaruhi sel-sel endotelial dari kapiler-kapiler miokardial, sehingga dapat menyebabkan fibrosis miokard. 2 Vasospame koroner juga dapat terjadi akibat komplikasi dari radiasi dan dapat menyebabkan kematian.…”