Radiotherapy is known to cause heart disease. A recent analysis challenges several long-held tenets, indicating that radiation-induced cardiotoxicity might occur at lower doses, and earlier, than generally believed. We must be mindful of this toxicity and limit cardiac radiation dose as much as possible.
Key Points
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Low planned doses of radiotherapy are associated with the development of ischaemic heart disease (absolute increase is small), with an interval between exposure and the development of disease shorter than previously accepted (years, not decades)
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Radiation oncologists have modern techniques that markedly reduce the dose of ionizing radiation to the heart when compared with older techniques; the therapeutic ratio of radiation is likely to be higher with more modern techniques
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References
Darby, S. C. et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N. Engl. J. Med. 368, 987–998 (2013).
Taylor, C. W., Nisbet, A., McGale, P. & Darby, S. C. Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int. J. Radiat. Oncol. Biol. Phys. 69, 1484–1495 (2007).
Taylor, C. W. et al. Cardiac doses from Swedish breast cancer radiotherapy since the 1950s. Radiother. Oncol. 90, 127–135 (2009).
Marks, L. B. et al. The incidence and functional consequences of RT-associated cardiac perfusion defects. Int. J. Radiat. Oncol. Biol. Phys. 63, 214–223 (2005).
Taylor, C. W. et al. Cardiac dose estimates from Danish and Swedish breast cancer radiotherapy during 1977–2001 Radiother. Oncol. 100, 176–183 (2011).
Giordano, S. H. et al. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J. Natl Cancer Inst. 97, 419–424 (2005).
Clarke, M. et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366, 2087–2106 (2005).
Lymberis, S. C. et al. Prospective assessment of optimal individual position (prone versus supine) for breast radiotherapy: volumetric and dosimetric correlations in 100 patients. Int. J. Radiat. Oncol. Biol. Phys. 84, 902–909 (2012).
Chino, J. P. & Marks, L. B. Prone positioning causes the heart to be displaced anteriorly within the thorax: implications for breast cancer treatment. Int. J. Radiat. Oncol. Biol. Phys. 70, 916–920 (2008).
Schubert, L. K. et al. Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiother. Oncol. 100, 241–246 (2011).
Acknowledgements
T. M. Zagar and L. B. Marks acknowledge support from the National Institutes of Health (grant CA69579).
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The Department of Radiation Oncology at the University of North Carolina receives grant support from Elekta, Morphormics, Siemens and Vision RT.
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Zagar, T., Marks, L. Risk of heart disease after radiotherapy—cause for concern. Nat Rev Clin Oncol 10, 310–312 (2013). https://doi.org/10.1038/nrclinonc.2013.59
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DOI: https://doi.org/10.1038/nrclinonc.2013.59
