Cardiac Complications of Oncologic Therapy

Walker, Christopher M.; Saldaña, David A.; Gladish, Gregory W.; Dicks, Demetrius; Kicska, Gregory; Mitsumori, Lee M.; Reddy, Gautham P.

doi:10.1148/rg.336125005

Cited by 32 publications

(30 citation statements)

References 46 publications

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“…10) In our case, the exercise stress thallium SPECT indicated myocardial ischemia in the basal-septal area, which corresponded to the CAG finding of occlusion of septal perforators. As the patient had no conventional coronary risk factors, the primary cause of the occlusion was probably the past radiation therapy for a mediastinal tumor, although it is uncertain when the septal perforators were occluded and why only septal perforators were occluded.…”

Section: Discussionsupporting

confidence: 77%

Radiation-Induced Coronary Artery Disease Manifested at Very Late Phase

et al. 2017

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SummaryWe report the case of a 51-year-old female, in whom coronary artery disease such as occlusion of septal perforators was manifested, on the occasion of hospitalization with congestive heart failure. The patient had a history of radiation therapy for a mediastinal tumor 19 years previously. As she had no conventional coronary risk factors, the cause of the coronary artery disease is thought to have been related to the radiation therapy. As survival rates of cancer patients improve as a consequence of therapeutic advances, we should be aware of the possibility of coronary artery disease as a very late complication of radiation therapy, even in patients who have no coronary risk factors.(Int Heart J 2017; 58: 993-997) Key words: Radiation therapy, Very late complication, Cardiovascular complication, Heart failure R adiation therapy has an important role as a mode of therapy for malignant tumors. When the irradiation is performed for lung, breast, or esophageal cancer, or for mediastinal tumors such as malignant lymphoma, other intrathoracic organs including the heart are also exposed to the radiation. This can cause coronary artery disease, constrictive pericarditis, valvular disease, and cardiomyopathy in the late stages.1) As the survival rates of intrathoracic malignant neoplasms have been improved by recent therapeutic developments, radiationinduced cardiovascular disease may become more common. Here we report a case with coronary artery disease manifested 19 years after radiation therapy for a mediastinal tumor. Case ReportA 51-year-old female suspected of having congestive heart failure was admitted to our hospital. She had a history of a mediastinal tumor, where information of histopathological diagnosis was absent, but she had received radiation therapy at a total dose of 64.8 Gy ( Figure 1A, B), 19 years previously. She had been experiencing palpitations and shortness of breath for six months, during which time the symptoms had gradually worsened. She had also been having attacks of nocturnal dyspnea at increasing frequency for the past month. On admission, her heart failure symptoms corresponded to New York Heart Association (NYHA) Class III. Her temperature, heart rate, and blood pressure were 36.1ºC, 120 beats/minute, and 148/94 mmHg, respectively. Jugular venous dilatation and edema of the lower extremities were absent. Blood oximetric oxygen saturation was 92% when breathing room air. A Levine II/VI pansystolic murmur and third heart sound were audible maximally at the apex.At admission, a chest roentgenogram showed mild pulmonary congestion and elevation of the left diaphragm, but no cardiomegaly (Figure 2A). An electrocardiogram had showed regular sinus rhythm and narrow QRS complex waves 3 years before ( Figure 2B), but complete left bundle branch block was present at admission. Figure 2C shows the electrocardiogram 2 days after admission. Blood cell counts and clinical chemistry were within the normal range, including levels of total cholesterol, triglycerides, and hemoglobin A1c (187 mg/dL,...

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Section: Discussionsupporting

confidence: 77%

Radiation-Induced Coronary Artery Disease Manifested at Very Late Phase

et al. 2017

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“…It is defined as inflammation of any of the serosal linings of the body, including the pleura, peritoneum and pericardium. 1 In the non-transplant setting, serosal inflammation can be caused by many different factors, including drugs, 2 infections, [3][4][5] exposure to ionizing radiation, 6,7 hereditary conditions, 8,9 autoimmune disorders 10 and malignant disease. [11][12][13] In the hematopoietic cell transplant (HCT) setting, serositis and pericardial effusions are seen as an 'other' manifestation in patients with established cGvHD and even in this setting attributing them to cGvHD is a diagnosis of exclusion.…”

Section: Introductionmentioning

confidence: 99%

Chronic GvHD-associated serositis and pericarditis

Leonard

Newell

Meyers

et al. 2015

Bone Marrow Transplant

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Serositis is a rare manifestation of chronic GvHD (cGvHD). No risk factors or laboratory changes associated with this syndrome have been recognized to date, and outcomes have not been described in a large series. We searched our institutional database for patients undergoing allogeneic hematopoietic cell transplant identified as having serositis or pericarditis. Laboratory studies from prior to diagnosis, at diagnosis and post diagnosis of serositis, as well as outcomes from invasive procedures were included. Twenty patients met criteria for cGvHD-associated serositis, and all but three patients had a prior diagnosis of cGvHD. Fifteen were male, and the complication occurred in the setting of immunosuppressant taper in 12 cases. Ten patients required invasive interventions, including pericardial window or stripping. A significant increase in blood monocytes and decrease in serum albumin were identified at diagnosis compared with pre-diagnosis. Out of 20 patients, 17 were treated with steroids, with 12 demonstrating a complete response. These data suggest that cGvHD-associated serositis occurs mainly in the setting of treated as opposed to de novo cGvHD and biomarkers associated with the syndrome include a decrease in albumin and an increase in absolute monocyte count. Outcome data from larger series are required to better understand the optimal management of this rare complication.

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“…For example, anthracycline‐related cardiotoxicity. Here the effects can occur many years later, and patients may be asymptomatic despite the damage . For childhood cancer survivors treated with anthracyclines or radiation to the cardiac field, regular assessment by echocardiography is recommended, particularly in the first and third trimesters of pregnancy…”

Section: Cancer and Pregnancymentioning

confidence: 99%

Survival from cancer in young people: An overview of late effects focusing on reproductive health

Newton

Friend

Feltbower

et al. 2019

Acta Obstet Gynecol Scand

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This paper provides a summary of the areas of survival from childhood, teenage and young adult cancers and the significant late effects that can arise from treatment; with particular focus on the area of reproductive health and the impact on both fertility and pregnancy. To complete this review, Web of Science and MEDLINE were used. Search terms included: “"survival AND childhood OR teenage OR young adult cancer", "late effects", "childhood cancer", "teenage AND/OR young adult cancer", AND "fertility after cancer" OR "pregnancy AND cancer" OR "fertility preservation”. Additionally, the clinical expertise of the authors was drawn upon. Childhood cancer is a thankfully rare occurrence; however, the incidence is increasing. Survival rates remain high and this means that a growing population of childhood and young adult cancer survivors are reaching adulthood. For some of these adults, although cured of their cancer, they are now facing a future with lasting effects on their health from their treatments. These effects, commonly referred to as late effects, are defined as health problems related either directly to the underlying cancer or to its treatment and which occur months or years after treatment has finished. Reproductive health is an important consideration for these patients, and although many will be able to conceive naturally, some will exhibit impaired fertility after their treatments. This can include difficulties at all points along the path from conception to delivery of a live, healthy offspring. High‐quality, large‐population evidence is sparse in many areas relating to fertility risk from treatment and the maternal and fetal health of childhood cancer survivors. Yet given the potential for complications, the authors advocate consideration of fertility at the time of diagnosis and before potentially gonadotoxic treatment.

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Cardiac Complications of Oncologic Therapy

Cited by 32 publications

References 46 publications

Radiation-Induced Coronary Artery Disease Manifested at Very Late Phase

Radiation-Induced Coronary Artery Disease Manifested at Very Late Phase

Chronic GvHD-associated serositis and pericarditis

Survival from cancer in young people: An overview of late effects focusing on reproductive health

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