Abstract
Cancer incidence and survivorship have had a rising tendency over the last two decades due to better treatment modalities. One of these is radiation therapy (RT), which is used in 20–55% of cancer patients, and its basic principle consists of inhibiting proliferation or inducing apoptosis of cancer cells. Classically, photon beam RT has been the mainstay therapy for these patients, but, in the last decade, proton beam has been introduced as a new option. This newer method focuses more on the tumor and affects less of the surrounding normal tissue, i.e., the heart. Radiation to the heart is a common complication of RT, especially in patients with lymphoma, breast, lung, and esophageal cancer. The pathophysiology is due to changes in the microvascular and macrovascular milieu that can promote accelerated atherosclerosis and/or induce fibrosis of the myocardium, pericardium, and valves. These complications occur days, weeks, or years after RT and the risk factors associated are high radiation doses (>30 Gy), concomitant chemotherapy (primarily anthracyclines), age, history of heart disease, and the presence of cardiovascular risk factors. The understanding of these mechanisms and risk factors by physicians can lead to a tailored assessment and monitorization of these patients with the objective of early detection or prevention of radiation-induced heart disease. Echocardiography is a noninvasive method which provides a comprehensive evaluation of the pericardium, valves, myocardium, and coronaries, making it the first imaging tool in most cases; however, other modalities, such as computed tomography, nuclear medicine, or cardiac magnetic resonance, can provide additional value.
Highlights
Cancer incidence and survivorship are rising; the global cancer statistics provided by the International Agency for Research on Cancer within the World Health Organization (WHO), which includes 185 countries around the world, estimate that, after 5 years of a cancer diagnosis, there is an estimated 51–71% survival rate
It is important to understand the pathophysiology of Radiation-induced heart disease (RIHD), the different techniques to improve radiation delivery while minimizing tissue damage, types of radiation, risk factors associated with RIHD, and how to diagnose early RIHD
In another study that included 7033 patients with Hodgkin disease who received chest radiation therapy (RT), the risk for death from myocardial infarction was double when compared to the general population and it persisted for 25 years after treatment [35]
Summary
Cancer incidence and survivorship are rising; the global cancer statistics provided by the International Agency for Research on Cancer within the World Health Organization (WHO), which includes 185 countries around the world, estimate that, after 5 years of a cancer diagnosis (mainly breast, colorectal, and prostate), there is an estimated 51–71% survival rate. The main goal of RT is to damage the genetic material of cancer cells, inhibiting their growth and replication This is accomplished by exposing the desired tissue to ionizing radiation which generates high-energy ions that deposit inside the cells, blocking their proliferation and/or inducing apoptosis [7]. Some of the increased risks of patients who receive RT when compared to the general population are the development of accelerated ischemic heart disease and valvular and pericardial disease [9,10] For this reason, it is important to understand the pathophysiology of RIHD, the different techniques to improve radiation delivery while minimizing tissue damage, types of radiation, risk factors associated with RIHD, and how to diagnose early RIHD
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