Constrictive Pericarditis 5 Months after Radiation Therapy in a 62-Year-Old Woman with Esophageal Cancer

Yeneneh, Beeletsega; Allen, Sorcha; Panse, Prasad M.; Mookadam, Farouk; Rule, William G.

doi:10.14503/thij-16-6054

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…While overall cancer survival rates have been increasing, identifying and managing potential side effects of cancer therapy remain a significant challenge, including those due to chemotherapy (medications designed to eliminate cancer cells), targeted cancer therapy (medications to inhibit specific molecules associated with carcinogenesis) [ 3 ], immunotherapy (novel therapeutic agents to retrain the affected immune system and restore their anti-cancer function) [ 4 ], and radiotherapy (use of ionizing radiation to eliminate cancer cells). These side effects include cardiac and vascular complications that are collectively referred to as cardiovascular toxicity (e.g., heart failure, myocardial ischemia/infarction, arrhythmias) [ 3 – 6 ], which may occur acutely [ 7 ] or chronically after initiating therapy [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The cumulative effects of these subcellular, cellular, and matrix changes are responsible for early (e.g., acute restrictive pericarditis [ 7 ]) and late cardiac damage (e.g., diastolic dysfunction [ 8 ]) associated with RT, with a median development time of 10-15 years for long-term toxicities [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The variably progressive nature of RT-induced MCT, which can lead to irrevocable pathological remodeling if unmitigated, creates a specific clinical need for detecting cardiovascular dysfunction at its earliest (and potentially reversible) stages when medical interventions might provide the greatest benefit. Early complications like constrictive pericarditis (preceded by shortness of breath symptom) may appear within one year after RT [ 7 ] with potentially reversible results if treated early while late effects like coronary artery disease and risk of sudden cardiac death may not manifest until 10-15 years later (with myocardial infarction and angina symptoms) [ 18 , 26 ] with a much lower possibility of successful medical interventions. Notably, early signs may be focal in nature, and thus may require detection methods capable of distinguishing the function of key substructures of the cardiovascular system.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative assessment of radiotherapy-induced myocardial damage using MRI: a systematic review

et al. 2023

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Purpose To determine the role of magnetic resonance imaging (MRI)-based metrics to quantify myocardial toxicity following radiotherapy (RT) in human subjects through review of current literature. Methods Twenty-one MRI studies published between 2011-2022 were identified from available databases. Patients received chest irradiation with/without other treatments for various malignancies including breast, lung, esophageal cancer, Hodgkin’s, and non-Hodgkin’s lymphoma. In 11 longitudinal studies, the sample size, mean heart dose, and follow-up times ranged from 10-81 patients, 2.0-13.9 Gy, and 0-24 months after RT (in addition to a pre-RT assessment), respectively. In 10 cross-sectional studies, the sample size, mean heart dose, and follow-up times ranged from 5-80 patients, 2.1-22.9 Gy, and 2-24 years from RT completion, respectively. Global metrics of left ventricle ejection fraction (LVEF) and mass/dimensions of cardiac chambers were recorded, along with global/regional values of T1/T2 signal, extracellular volume (ECV), late gadolinium enhancement (LGE), and circumferential/radial/longitudinal strain. Results LVEF tended to decline at >20 years follow-up and in patients treated with older RT techniques. Changes in global strain were observed after shorter follow-up (13±2 months) for concurrent chemoradiotherapy. In concurrent treatments with longer follow-up (8.3 years), increases in left ventricle (LV) mass index were correlated with LV mean dose. In pediatric patients, increases in LV diastolic volume were correlated with heart/LV dose at 2 years post-RT. Regional changes were observed earlier post-RT. Dose-dependent responses were reported for several parameters, including: increased T1 signal in high-dose regions, a 0.136% increase of ECV per Gy, progressive increase of LGE with increasing dose at regions receiving >30 Gy, and correlation between increases in LV scarring volume and LV mean/V10/V25 Gy dose. Conclusion Global metrics only detected changes over longer follow-up, in older RT techniques, in concurrent treatments, and in pediatric patients. In contrast, regional measurements detected myocardial damage at shorter follow-up and in RT treatments without concurrent treatment and had greater potential for dose-dependent response. The early detection of regional changes suggests the importance of regional quantification of RT-induced myocardial toxicity at early stages, before damage becomes irreversible. Further works with homogeneous cohorts are required to examine this matter.

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