Breast Radiotherapy and Early Adverse Cardiac Effects. The Role of Serum Biomarkers and Strain Echocardiography

Gkantaifi, Areti; Papadopoulos, Christodoulos; Spyropoulou, Despoina; Toumpourleka, Maria; Iliadis, Georgios; Kardamakis, Dimitrios; Nikolaou, Michail; Tsoukalas, Nikolaos; Kyrgias, G.; Tolia, Maria

doi:10.21873/anticanres.13272

Cited by 22 publications

(19 citation statements)

References 49 publications

(52 reference statements)

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“…Treatment protocols of patients with primary breast cancer most often include radiotherapy following breast-conserving surgery or mastectomy (2). Radiotherapy for breast cancer can be associated with acute and late toxicities (19)(20)(21). Being scheduled for radiotherapy may cause psychological distress that can lead to significant sleep disorders.…”

Section: Discussionmentioning

confidence: 99%

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

Rades

Narvaez

Schild

et al. 2021

In Vivo

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Background/Aim: The anticipation of radiotherapy can cause distress and sleep disorders, which may be aggravated by the COVID-19 pandemic. This study investigated sleep disorders in a large cohort of patients with breast cancer before and during the pandemic. Patients and Methods: Twenty-three characteristics were retrospectively analyzed for associations with pre-radiotherapy sleep disorders in 338 patients. Moreover, 163 patients presenting before and 175 patients presenting during the COVID-19 pandemic were compared for sleep disorders. Results: Sleep disorders were significantly associated with age ≤60 years (p=0.006); high distress score (p<0.0001); more emotional (p<0.0001), physical (p<0.0001) or practical (p<0.0001) problems; psycho-oncological need (p<0.0001); invasive cancer (p=0.003); chemotherapy (p<0.001); and hormonal therapy (p=0.006). Sleep disorders were similarly common in both groups (prior to vs. during the pandemic: 40% vs. 45%, p=0.38). Conclusion: Although additional significant risk factors for sleep disorders were identified, the COVID-19 pandemic appeared to have no significant impact on sleep disorders in patients scheduled for irradiation of breast cancer.Breast cancer is one of the most common cancer types worldwide (1). In the vast majority of patients with primary breast cancer, the treatment regimen includes adjuvant radiotherapy (2). Being scheduled for radiotherapy can cause significant distress for patients, which may be associated with sleep disorders. According to previous studies, sleep disorders are quite common in patients with breast cancer (3,4).Controversy exists regarding the point in time during a patient's course when sleep orders are most prevalent. In a study that investigated sleeping habits in 33 patients with breast cancer and 23 with prostate cancer during a course of radiotherapy plus 6-month follow-up, sleep disorders occurred mainly before and at the beginning of the treatment (5). In a population-based epidemiological study including 465 patients with breast cancer and 263 with prostate cancer, sleep disorders increased during the period of treatment due to radiationrelated side-effects (6). To date, only a few studies have investigated the prevalence of pre-radiotherapy sleep disorders and corresponding risk factors (4, 7, 8). Therefore, a major goal of the current study was the identification of additional risk factors for pre-radiotherapy sleep disorders in a large cohort of patients with primary breast cancer.Distress and pre-radiotherapy sleep disorders may be aggravated by the Coronavirus Disease 2019 (COVID-19) pandemic. The majority of patients with cancer belong to the high-risk group because of immuno-suppression due to malignant disease or anticancer treatment (9-12). The studies reported so far have provided conflicting results regarding the impact of the COVID-19 pandemic on distress and sleep disorders in patients with cancer (13)(14)(15)(16)(17). No study has particularly focused on the impact of the COVID-19 pandemic on the prevalence of slee...

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Section: Discussionmentioning

confidence: 99%

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

Rades

Narvaez

Schild

et al. 2021

In Vivo

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“…Melatonin may have protective effects on the heart through direct free radical scavenging and indirectly through its antioxidant properties [90]. The mechanism of melatonin scavenging free radicals seems to be different from most of the other antioxidants because melatonin interacts with ROS without stimulating the redox system; furthermore, melatonin converts free radicals into stable products, which 10 Oxidative Medicine and Cellular Longevity basically do not react with other molecules [26]. In addition, the antioxidant effect of melatonin involves the donation of two electrons, which do not become free radicals after providing electrons to free radicals and neutralizing free radicals to protect cells from free radical attacks.…”

Section: Resveratrolmentioning

confidence: 99%

“…The available data show that the higher the radiation dose, the stronger is the cardiotoxicity, and the risk of cardiovascular complications is also increased. Moreover, the risk of cardiovascular complications in patients who received radiotherapy for left breast cancer was significantly higher than the risk in patients who received radiotherapy for right breast cancer [10]. Although the benefit of radiotherapy is obvious, increasing attention has been paid to the cardiac damage induced by radiotherapy, which would suggest limiting the dose and use of radiotherapy in cancer patients [11].…”

Section: Introductionmentioning

confidence: 99%

Oxidative Stress in Radiation-Induced Cardiotoxicity

Zhang

Yang

Liu

et al. 2020

Oxidative Medicine and Cellular Longevity

115

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There is a distinct increase in the risk of heart disease in people exposed to ionizing radiation (IR). Radiation-induced heart disease (RIHD) is one of the adverse side effects when people are exposed to ionizing radiation. IR may come from various forms, such as diagnostic imaging, radiotherapy for cancer treatment, nuclear disasters, and accidents. However, RIHD was mainly observed after radiotherapy for chest malignant tumors, especially left breast cancer. Radiation therapy (RT) has become one of the main ways to treat all kinds of cancer, which is used to reduce the recurrence of cancer and improve the survival rate of patients. The potential cause of radiation-induced cardiotoxicity is unclear, but it may be relevant to oxidative stress. Oxidative stress, an accumulation of reactive oxygen species (ROS), disrupts intracellular homeostasis through chemical modification and damages proteins, lipids, and DNA; therefore, it results in a series of related pathophysiological changes. The purpose of this review was to summarise the studies of oxidative stress in radiotherapy-induced cardiotoxicity and provide prevention and treatment methods to reduce cardiac damage.

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“…Increased CRP level was associated with the severity of radiation-induced cardiomyopathy after radiation therapy of lung or breast cancer (18). We have shown elevated levels of inflammatory cytokines such as interleukin (IL)-1, IL-6, and tissue necrosis factor alpha (TNF-α) in serum after local cardiac irradiation in mice (19), but data on their role in the prediction of myocardial changes in clinical trials are lacking to date (20,21).…”

Section: Introductionmentioning

confidence: 99%

Data-Independent Acquisition Proteomics Reveals Long-Term Biomarkers in the Serum of C57BL/6J Mice Following Local High-Dose Heart Irradiation

Azimzadeh

Toerne

Subramanian

et al. 2021

Front. Public Health

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Background and Purpose: Cardiotoxicity is a well-known adverse effect of radiation therapy. Measurable abnormalities in the heart function indicate advanced and often irreversible heart damage. Therefore, early detection of cardiac toxicity is necessary to delay and alleviate the development of the disease. The present study investigated long-term serum proteome alterations following local heart irradiation using a mouse model with the aim to detect biomarkers of radiation-induced cardiac toxicity.Materials and Methods: Serum samples from C57BL/6J mice were collected 20 weeks after local heart irradiation with 8 or 16 Gy X-ray; the controls were sham-irradiated. The samples were analyzed by quantitative proteomics based on data-independent acquisition mass spectrometry. The proteomics data were further investigated using bioinformatics and ELISA.Results: The analysis showed radiation-induced changes in the level of several serum proteins involved in the acute phase response, inflammation, and cholesterol metabolism. We found significantly enhanced expression of proinflammatory cytokines (TNF-α, TGF-β, IL-1, and IL-6) in the serum of the irradiated mice. The level of free fatty acids, total cholesterol, low-density lipoprotein (LDL), and oxidized LDL was increased, whereas that of high-density lipoprotein was decreased by irradiation.Conclusions: This study provides information on systemic effects of heart irradiation. It elucidates a radiation fingerprint in the serum that may be used to elucidate adverse cardiac effects after radiation therapy.

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Breast Radiotherapy and Early Adverse Cardiac Effects. The Role of Serum Biomarkers and Strain Echocardiography

Cited by 22 publications

References 49 publications

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

Oxidative Stress in Radiation-Induced Cardiotoxicity

Data-Independent Acquisition Proteomics Reveals Long-Term Biomarkers in the Serum of C57BL/6J Mice Following Local High-Dose Heart Irradiation

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