Radiation-associated cardiovascular disease

M. Jacob Adams, Patricia H. Hardenbergh, Louis S. Constine, Steven E. Lipshultz

Research output: Contribution to journalReview articlepeer-review

372 Scopus citations

Abstract

As the number of cancer survivors grows because of advances in therapy, it has become more important to understand the long-term complications of these treatments. This article presents the current knowledge of adverse cardiovascular effects of radiotherapy to the chest. Emphasis is on clinical presentations, recommendations for follow-up, and treatment of patients previously exposed to irradiation. Medline™ literature searches were performed, and abstracts related to this topic from oncology and cardiology meetings were reviewed. Potential adverse effects of mediastinal irradiation are numerous and can include coronary artery disease, pericarditis, cardiomyopathy, valvular disease and conduction abnormalities. Damage appears to be related to dose, volume and technique of chest irradiation. Effects may initially present as subclinical abnormalities on screening tests or as catastrophic clinical events. Estimates of relative risk of fatal cardiovascular events after mediastinal irradiation for Hodgkin's disease ranges between 2.2 and 7.2 and after irradiation for left-sided breast cancer from 1.0 to 2.2. Risk is life long, and absolute risk appears to increase with length of time since exposure. Radiation-associated cardiovascular toxicity may in fact be progressive. Long-term cardiac follow-up of these patients is therefore essential, and the range of appropriate cardiac screening is discussed, although no specific, evidence-based screening regimen was found in the literature.

Original languageEnglish (US)
Pages (from-to)55-75
Number of pages21
JournalCritical Reviews in Oncology/Hematology
Volume45
Issue number1
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

Keywords

  • Anthracyclines
  • Arrhythmia
  • Breast cancer
  • Cardiomyopathy
  • Cardiovascular disease
  • Coronary artery disease
  • Heart disease
  • Hodgkin's disease
  • Pericarditis
  • Radiation therapy
  • Valvular disease

ASJC Scopus subject areas

  • Cancer Research
  • Hematology
  • Oncology

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