Accelerated Atherosclerosis and Cardiovascular Toxicity Induced by Radiotherapy in Breast Cancer

Abstract

The number of patients diagnosed with breast cancer and cardiovascular disease is continuously rising. Treatment options for breast cancer have greatly evolved, but radiotherapy (RT) still has a key role in it. Despite many advances in RT techniques, cardiotoxicity is one of the most important side effects. The new cardio-oncology guidelines recommend a baseline evaluation, risk stratification and follow-up of these patients. Cardiotoxicity induced by RT can be represented by almost all forms of cardiovascular disease, with atherosclerosis being the most frequent. An interdisciplinary team should manage these patients, in order to have maximum therapeutic effect and minimum cardiovascular toxicity. This review will summarize the current incidence, risk factors, mechanisms and follow-up of RT-induced cardiovascular toxicity.

Evaluation of Tumor Control and Normal Tissue Complication Probabilities in Patients Receiving Comprehensive Nodal Irradiation for Left-Sided Breast Cancer

“…When indicated either after conservative breast surgery or after mastectomy, radiation therapy improves local control, disease-free, and overall survival by preventing local recurrence and metastatic disease [ 2 ]. Currently, the multimodality approach used to treat BC has been associated with elevated cardiac mortality since anthracycline-based chemotherapy, ERBB2 antagonists, endocrine therapy, and breast irradiation are linked to an elevated risk of lung disease, coronary artery disease, and a broad spectrum of cardiac anomalies like cardiac ischemia, heart failure, valvular heart disease, QT interval prolongation, and arrhythmias [ 3 ]. Cardiac-protective radiotherapy techniques like deep inspiration breath hold (DIBH) have evolved through time to decrease the incidence of cardiac death and coronary events, therefore allowing moderate hypofractionation and ultra-short radiotherapy schemes as a more convenient technique for patients and health institutions [ 4 ].…”