Radiation-induced myocardial fibrosis: Mechanisms underlying its pathogenesis and therapeutic strategies.

Bin Wang,Jinlong Wei,Huanhuan Wang,Ying Xin,Mengmeng Zhang,Xin Jiang,Rui Ji

doi:10.1111/jcmm.15479

Abstract

Radiation‐induced myocardial fibrosis (RIMF) is a potentially lethal clinical complication of chest radiotherapy (RT) and a final stage of radiation‐induced heart disease (RIHD). RIMF is characterized by decreased ventricular elasticity and distensibility, which can result in decreased ejection fraction, heart failure and even sudden cardiac death. Together, these conditions impair the long‐term health of post‐RT survivors and limit the dose and intensity of RT required to effectively kill tumour cells. Although the exact mechanisms involving in RIMF are unclear, increasing evidence indicates that the occurrence of RIMF is related to various cells, regulatory molecules and cytokines. However, accurately diagnosing and identifying patients who may progress to RIMF has been challenging. Despite the urgent need for an effective treatment, there is currently no medical therapy for RIMF approved for routine clinical application. In this review, we investigated the underlying pathophysiology involved in the initiation and progression of RIMF before outlining potential preventative and therapeutic strategies to counter this toxicity.

Highlights

In recent decades, chest RT has been an effective part of clinical multimodality therapy for breast cancer, Hodgkin's lymphoma, oesophageal cancer, lung cancer and other malignancies involving the intrathoracic and chest wall regions.[1]
radiation-induced heart disease (RIHD) can involve any part of the heart, from subclinical histopathologic changes to obvious clinical disease such as conduction system abnormalities, cardiomyopathy, pericarditis, valvular heart disease, coronary artery disease and myocardial fibrosis.[4]
We describe the underlying pathophysiology of Radiation-induced myocardial fibrosis (RIMF) and outline potential preventative and therapeutic strategies to counter this toxicity, providing references for the management of RIMF

Summary

Introduction

Chest RT has been an effective part of clinical multimodality therapy for breast cancer, Hodgkin's lymphoma, oesophageal cancer, lung cancer and other malignancies involving the intrathoracic and chest wall regions.[1].

Results

Conclusion