Cardiac Substructures Dosimetric Predictors for Cardiac Toxicity After Definitive Radiotherapy in Esophageal Cancer

Early Cardio-Oncology Intervention in Thoracic Radiotherapy: Results of the Cardiac Aggressive Risk Mitigation (CARMA) Pilot Study

“…However, patients with cancer are frequently under-optimized for cardiovascular (CV) risk 2 , including less than half of high CV risk patients on statin therapy 3,4 . Coronary artery radiation exposure can accelerate the natural history of atherosclerosis 5 and has been associated with an increased risk of major cardiac events in patients with lung 6-9 , esophageal 10,11 , and breast 12,13 cancers. While RT associated CV toxicity was historically presumed to have a prolonged latency to clinical manifestation, recent evidence observes a more compressed timeframe following high dose thoracic RT, with 2 year cardiac event rates up to 10-20% and related to baseline CV risk and coronary radiation dose exposure 6,10,11,14 .…”

“…Coronary artery radiation exposure can accelerate the natural history of atherosclerosis 5 and has been associated with an increased risk of major cardiac events in patients with lung 6-9 , esophageal 10,11 , and breast 12,13 cancers. While RT associated CV toxicity was historically presumed to have a prolonged latency to clinical manifestation, recent evidence observes a more compressed timeframe following high dose thoracic RT, with 2 year cardiac event rates up to 10-20% and related to baseline CV risk and coronary radiation dose exposure 6,10,11,14 . Further, statin therapy has been shown to be protective for stroke risk in patients receiving head and neck or thoracic RT 15 and has been associated with improved survival in a dose-dependent manner following lung cancer chemoradiotherapy 3,16 .…”

Low doses to the heart in daily practice for treating left-sided breast cancer using accelerated partial-breast irradiation by multicatheter brachytherapy and deep-inspiration breath-hold using a SIB

“…Radiation-related cardiac toxicity is a late-occurring event, manifesting clinically 10 or more years after breast cancer treatment [ 7 ] so that late sequelae observed clinically today reflect radiation techniques used in clinical practice 10 years ago. Moreover, doses to cardiac substructures like the LAD are predictive for defined cardiac events after radiation therapy, as shown for esophageal cancer [ 8 ]. With modern treatment techniques, the rate of serious sequelae may be lower than previously thought [ 9 ] and several modern radiotherapy techniques significantly improved the therapeutic ratio [ 10 ].…”

Pericardial irradiation dose may be strongly associated with grade 4 lymphopenia and affect prognosis in patients with locally advanced esophageal cancer receiving definitive concurrent chemoradiotherapy

“…Several studies have already been published which have explored the potential relationship between higher doses of irradiation to the heart and clinical outcomes for patients 3–6 . Very recently, the study by Cai et al demonstrated that radiation exposure to the left anterior descending (LAD) and left circumflex (LCX) was strongly correlated with worse OS and was an excellent predictor of G3+ acute coronary syndrome/congestive heart failure 7 …”

“…[3][4][5][6] Very recently, the study by Cai et al demonstrated that radiation exposure to the left anterior descending (LAD) and left circumflex (LCX) was strongly correlated with worse OS and was an excellent predictor of G3+ acute coronary syndrome/congestive heart failure. 7 Myelosuppression is also a common side effect of antineoplastic therapy, and lymphocytopenia has been found to be significantly linked to patient treatment outcomes. Since lymphocytes are the most radiosensitive cells in the hematopoietic system, and the heart and lungs, as specific organs of the blood pool, receive high doses of radiation that may damage circulating lymphocytes.…”