Cardiac side effects of conventional and particle radiotherapy in cancer patients

Review Radiotherapy and anthracyclines – cardiovascular toxicity

“…It is estimated that radiotherapy-induced cardiovascular diseases occur in 10% to 30% of patients within 5–10 years following treatment. In 88% of patients the abnormalities are asymptomatic [ 12 ], and thus the disclosure of pathological cardiovascular lesions is often delayed, and as such can often be misleading [ 13 ]. It is important that patients treated with ionizing radiation are systematically monitored by methods of cardiac diagnosis recommended for these patients ( Table 2 ), as radiation can cause a wide variety of pathological cardiovascular manifestations ( Table 1 ).…”

“…This accumulation leads to the replacement of the peripheral pericardial fat pad, increasing the thickness of the fibrous layer [ 15 ]. Production of protein-rich fluid inside the pericardial sac occurs and its rapid accumulation may even lead to lethal cardiac tamponade [ 12 , 15 ].…”

“…Consequently, congestive cardiac muscle failure occurs. These complications correlate with extensive fibrosis and microvascular damage leading to occlusion of capillaries [ 12 ], whereas systolic myocardial dysfunction may occur following combined treatment with anthracyclines [ 16 ].…”

“…There are two hypotheses explaining the biological mechanisms that lead to a higher incidence and mortality due to blood vessel diseases resulting from ionizing radiation treatment. The first states that radiation increases the occurrence of myocardial infarction by intravascular proliferation and accelerated development of atherosclerosis in the arteries [ 12 , 15 , 18 ]. Blood vessel arteriosclerosis may lead to fatal cardiac ischemic necrosis [ 6 ].…”

“…The second hypothesis is that the radiotherapy-induced increased mortality is related to the decrease in myocardial tolerance to the above-mentioned acute ischemic necrosis induced by microvascular disorders. It is worth noting that these hypotheses are not mutually exclusive, and the mechanisms described may occur simultaneously, contributing to the development of clinical cardiac diseases [ 12 ].…”