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Cardiac Complications and Cardiotoxicity of Radiation Therapy
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Cardiac Complications and Cardiotoxicity of Radiation Therapy

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 8227

Special Issue Editors

Dr. Sophie Jacob

E-Mail Website
Guest Editor
Laboratory of Radiation Epidemiology, Institute for Radiological Protection and Nuclear Safety (IRSN), 31 Avenue de la Division Leclerc, 92262 Fontenay-aux-Roses, France
Interests: radiation-induced heart diseases; thoracic radiotherapy; breast cancer; clinical epidemiology; dose-response modeling
Prof. Dr. Carlo De Asmundis

E-Mail Website
Guest Editor
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium
Interests: arrhythmias; atrial fibrillation; ablation; stroke; pathophysiology; implantable cardioverter defibrillators
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Juliette Thariat

E-Mail Website
Guest Editor
François Baclesse Cancer Center, Department of Radiation Oncology, 3, Avenue du Général Harris, 14000 Caen, France
Interests: radiotherapy; proton therapy; breast cancer; head and neck cancer; dosimetry; cardiotoxicity

Special Issue Information

Dear Colleagues,

Radiation therapy improves locoregional tumor control and the overall survival of patients with solid tumors, such as breast, lung, and esophageal cancers, and Hodgkin’s lymphoma. Nevertheless, radiation therapy results in incidental radiation exposure of the heart, which increases the risk of cardiotoxicity. Although the benefits of radiation therapy far outweigh the risk of developing subsequent cardiovascular diseases, there is ongoing debate regarding the safest radiation dose, which cardiac substructures are most sensitive to radiotherapy, and the most appropriate strategies for prevention. This debate is complicated by the need to assess the effects of modern radiotherapy techniques and protocols in fast moving development (IMRT, VMAT, proton beam therapy, and adaptive radiotherapy), and the need to evaluate how the incidence of cardiovascular complications may vary according to patient risk factors and the synergistic effects of radiation with other cardiotoxic oncology treatments.

The aim of this Special Issue is to provide an overview and new elements concerning the mentioned current debate on the cardiovascular complications and cardiotoxicity of radiation therapy. This could be covered by large epidemiological studies, clinical studies with advanced imaging and diagnostic techniques, and radiation dosimetry research, but also through radiobiological and mechanistic studies, as well as review articles.

Dr. Sophie Jacob
Prof. Dr. Carlo De Asmundis
Prof. Dr. Juliette Thariat
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • coronary artery disease
  • myocardial dysfunction
  • arrhythmia
  • heart diseases
  • early and late effects
  • cardiac imaging
  • biomarkers
  • dosimetry
  • cardiac substructures
  • modern techniques radiotherapy

Published Papers (5 papers)

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Research

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13 pages, 969 KiB  
Article
Percutaneous Coronary Intervention Mortality, Cost, Complications, and Disparities after Radiation Therapy: Artificial Intelligence-Augmented, Cost Effectiveness, and Computational Ethical Analysis
by Dominique J. Monlezun
J. Cardiovasc. Dev. Dis. 2023, 10(11), 445; https://doi.org/10.3390/jcdd10110445 - 30 Oct 2023
Cited by 1 | Viewed by 1613
Abstract
The optimal cardio-oncology management of radiation therapy and its complications are unknown despite the high patient and societal costs. This study is the first known nationally representative, multi-year, artificial intelligence and propensity score-augmented causal clinical inference and computational ethical and policy analysis of [...] Read more.
The optimal cardio-oncology management of radiation therapy and its complications are unknown despite the high patient and societal costs. This study is the first known nationally representative, multi-year, artificial intelligence and propensity score-augmented causal clinical inference and computational ethical and policy analysis of percutaneous coronary intervention (PCI) mortality, cost, and disparities including by primary malignancy following radiation therapy. Bayesian Machine learning-augmented Propensity Score translational (BAM-PS) statistics were conducted in the 2016–2020 National Inpatient Sample. Of the 148,755,036 adult hospitalizations, 2,229,285 (1.50%) had a history of radiation therapy, of whom, 67,450 (3.00%) had an inpatient AMI, and of whom, 18,400 (28.69%) underwent PCI. Post-AMI mortality, costs, and complications were comparable with and without radiation across cancers in general and across the 30 primary malignancies tested, except for breast cancer, in which PCI significantly increased mortality (OR 3.70, 95%CI 1.10–12.43, p = 0.035). In addition to significant sex, race, and insurance disparities, significant regional disparities were associated with nearly 50 extra inpatient deaths and over USD 500 million lost. This large clinical, cost, and pluralistic ethical analysis suggests PCI when clinically indicated should be provided to patients regardless of sex, race, insurance, or region to generate significant improvements in population health, cost savings, and social equity. Full article
(This article belongs to the Special Issue Cardiac Complications and Cardiotoxicity of Radiation Therapy)
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15 pages, 1349 KiB  
Article
Detection of Early Myocardial Dysfunction by Imaging Biomarkers in Cancer Patients Undergoing Photon Beam vs. Proton Beam Radiotherapy: A Prospective Study
by Muhannad Aboud Abbasi, Giulia Bruno, Cristina Di Stefano, Laura Garcia Bello, Nadia N. Laack, Kimberly S. Corbin, Thomas J. Whitaker, Patricia A. Pellikka, Robert W. Mutter and Hector R. Villarraga
J. Cardiovasc. Dev. Dis. 2023, 10(10), 418; https://doi.org/10.3390/jcdd10100418 - 4 Oct 2023
Viewed by 1556
Abstract
1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March [...] Read more.
1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March 2016 and March 2017, 70 patients with breast or thoracic cancer were prospectively enrolled and underwent transthoracic echocardiography with comprehensive strain analysis at pretreatment, mid-treatment, end of treatment, and 3 months after RT. 3. Results: PBT was used to treat 44 patients; PhT 26 patients. Mean ± SD age was 55 ± 12 years; most patients (93%) were women. The median (interquartile range) of the mean heart dose was lower in the PBT than the PhT group (47 [27–79] vs. 217 [120–596] cGy, respectively; p < 0.001). Ejection fraction did not change in either group. Only the PhT group had reduced systolic tissue Doppler velocities at 3 months. 2D-STE showed changes in endocardial and epicardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing PhT (global longitudinal SRe, pretreatment vs. end of treatment (p = 0.04); global circumferential SRe, pretreatment vs. at 3-month follow-up (p = 0.003); global radial SRe, pretreatment vs. at 3-month follow-up (p = 0.02) for endocardial values). Epicardial strain values decreased significantly only in patients treated with PhT. Patients in the PhT group had a significant decrease in epicardial global longitudinal systolic strain rate (GLSRs) (epicardial GLSRs, at baseline vs. at end of treatment [p = 0.009]) and in GCSRe and GRSRe (epicardial GCSRe, at baseline vs. at 3-month follow-up (p = 0.02); epicardial GRSRe, at baseline vs. at 3-month follow-up (p = 0.03)) during treatment and follow-up. No changes on 2D-STE were detected in the PBT group. 4. Conclusions: Patients who underwent PhT but not PBT had reduced tissue Doppler velocities and SRe values during follow-up, suggesting early myocardial relaxation abnormalities. PBT shows promise as a cardiac-sparing RT technology. Full article
(This article belongs to the Special Issue Cardiac Complications and Cardiotoxicity of Radiation Therapy)
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14 pages, 1482 KiB  
Article
Early Development of Atherosclerotic Plaques in the Coronary Arteries after Radiotherapy for Breast Cancer (BACCARAT Study)
by Manoj Kumar Honaryar, Rodrigue Allodji, Gaelle Jimenez, Mathieu Lapeyre, Loic Panh, Jeremy Camilleri, David Broggio, Jean Ferrières, Florent De Vathaire and Sophie Jacob
J. Cardiovasc. Dev. Dis. 2023, 10(7), 299; https://doi.org/10.3390/jcdd10070299 - 12 Jul 2023
Cited by 1 | Viewed by 1534
Abstract
Background—Radiotherapy (RT) for breast cancer (BC) can lead to an increased risk of coronary artery disease several years after RT. The aim of this study was to evaluate the development of overall, non-calcified and calcified atherosclerotic plaques over 2 years after BC for [...] Read more.
Background—Radiotherapy (RT) for breast cancer (BC) can lead to an increased risk of coronary artery disease several years after RT. The aim of this study was to evaluate the development of overall, non-calcified and calcified atherosclerotic plaques over 2 years after BC for RT and associations with cardiac exposure. Methods—The study included 101 left- or right-sided BC patients treated with RT without chemotherapy. A coronary CT angiography was performed before and 2 years after RT. Plaque development thorough the entire coronary network was defined as an increased number of plaques. Cardiac exposure was quantified with mean doses to the heart, left ventricle, and coronary arteries. Logistic regression models were used to assess association with doses. Results—At inclusion, 37% of patients had plaques, increasing to 42% two years after RT. Overall plaque development was observed in seven patients: five with calcified plaque development and four with non-calcified plaque development. The risk of overall plaque development was significantly associated with doses to the Left Main and Circumflex coronary arteries (OR at 1 Gy = 2.32, p = 0.03 and OR at 1 Gy = 2.27, p = 0.03, respectively). Specific analyses for calcified and non-calcified plaque development showed similar results. Conclusion—Our study suggests an association between coronary arteries exposure and the risk of developing both calcified and non-calcified atherosclerotic plaques over 2 years after BC RT. Trial registration number: NCT02605512. Full article
(This article belongs to the Special Issue Cardiac Complications and Cardiotoxicity of Radiation Therapy)
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Review

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12 pages, 1033 KiB  
Review
Cardiovascular Toxicities of Radiation Therapy and Recommended Screening and Surveillance
by Gabriela Narowska, Sakshi Gandhi, Allison Tzeng and Eman A. Hamad
J. Cardiovasc. Dev. Dis. 2023, 10(11), 447; https://doi.org/10.3390/jcdd10110447 - 31 Oct 2023
Viewed by 1485
Abstract
Radiation therapy is a key part of treatment for many cancers. Vast advancements in the field of radiation oncology have led to a decrease in malignancy-related mortality, which has uncovered some of the long-term side effects of radiation therapy. Specifically, there has been [...] Read more.
Radiation therapy is a key part of treatment for many cancers. Vast advancements in the field of radiation oncology have led to a decrease in malignancy-related mortality, which has uncovered some of the long-term side effects of radiation therapy. Specifically, there has been an increase in research looking into the cardiovascular side effects of chest radiation therapy for cancers of the esophagus, breast, and lung tissue as well as lymphomas. The manifestations of cardiac injury from irradiation range from short-term complications, such as pericarditis, to long-term damage including cardiomyopathy, valvular disease, and conduction disturbances. The aims of this article are to describe the cardiovascular side effects and the associated risk factors, to discuss risk reduction strategies, and to provide guidance in pre-radiation screening, post-radiation surveillance, and the management of these conditions. Full article
(This article belongs to the Special Issue Cardiac Complications and Cardiotoxicity of Radiation Therapy)
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Other

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9 pages, 2524 KiB  
Case Report
Plaque Rupture in a Hodgkin Lymphoma Survivor without Cardiovascular Risk Factors 20 Years after Thoracic Radiotherapy: A Case Report
by Elissa A. S. Polomski, Michiel A. de Graaf, J. Wouter Jukema and M. Louisa Antoni
J. Cardiovasc. Dev. Dis. 2023, 10(8), 324; https://doi.org/10.3390/jcdd10080324 - 31 Jul 2023
Cited by 1 | Viewed by 1303
Abstract
Background: Major improvements in cancer therapies have significantly contributed to increased survival rates of Hodgkin lymphoma (HL) survivors, outweighing cardiovascular side effects and the risks of radiation-induced heart disease. Non-invasive screening for coronary artery disease (CAD) starting five years after irradiation is recommended, [...] Read more.
Background: Major improvements in cancer therapies have significantly contributed to increased survival rates of Hodgkin lymphoma (HL) survivors, outweighing cardiovascular side effects and the risks of radiation-induced heart disease. Non-invasive screening for coronary artery disease (CAD) starting five years after irradiation is recommended, as plaque development and morphology may differ in this high-risk population. Due to rapid plaque progression and a possibly higher incidence of non-calcified plaques, coronary artery calcium scoring may not be sufficient as a screening modality in HL survivors treated with thoracic radiotherapy. Case summary: A 42-year-old man with a history of HL treated with thoracic radiotherapy presented at the emergency department 20 years after cancer treatment with an ST-elevation myocardial infarction, in the absence of cardiovascular risk factors, for which primary percutaneous coronary intervention of the left anterior descending artery was performed. Four months prior to acute myocardial infarction, invasive coronary angiography only showed wall irregularities. Two years earlier, the Agatston calcium score was zero. Discussion: In HL survivors treated with thoracic radiotherapy, a calcium score of zero may not give the same warranty period for cardiac event-free survival compared to the general population. Coronary computed tomography angiography can be a proper diagnostic tool to detect CAD at an early stage after mediastinal irradiation, as performing calcium scoring may not be sufficient in this population to detect non-calcified plaques, which may show rapid progression and lead to acute coronary syndrome. Also, intensive lipid-lowering therapy should be considered in the presence of atherosclerosis in this patient population. Full article
(This article belongs to the Special Issue Cardiac Complications and Cardiotoxicity of Radiation Therapy)
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