Short and long term radiation induced cardiovascular disease in patients with cancer

Abstract

Radiation-induced cardiovascular disease is well described as a late effect in cancer patients treated with radiation therapy. Advancements in surgery, radiotherapy, and chemotherapy have led to an increasing number of cancer survivors with resultant long-term side effects related to their cancer treatments. In this review, we describe the short- and long-term cardiovascular consequences of mediastinal radiotherapy and discuss the optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients.

Keywords: Cardiovascular disease; Prevention; Radiotherapy.

Conflict of interest statement

The authors declare no potential conflicts of interest.

© 2017 Wiley Periodicals, Inc.

Figures

Figure 1

ECG and Echocardiogram showing pericarditis/pericardial effusion related to radiation therapy. (A): ECG shows diffuse ST elevation suggestive of pericarditis. (B): Echocardiogram (subcostal view) showing small pericardial effusion during attack of recurrence. (C): Echocardiogram (subcostal view) showing complete resolution of the pericardial effusion. A 60 year female with left lung cancer, who presented in April 2014, within 2 weeks of radiation therapy with typical pain of pericarditis. She had recurrence of pericarditis in Nov 14, for which she was given NSAID and cochicine with good effect.

Figure 2

Myocardial perfusion study showing ischemia in the inferior wall (region of radiation theraphy). A 57 year old asymptomatic man, who had received a total of 50 Gy radiation 2 years previously for cancer esophagus. Myocardial perfusion study shows ischemia in the inferior wall.

Figure 3

Echocardiogram showing moderate arotic stenosis mild regurgitation. A 57 year old man with history of Hodgkin's lymphoma treated with mediastinal radiation in 1982. In February 2012 he was evaluated because of symptoms of fatigue. Echocardiogram showed mild mitral annular calcification and moderate calcific aortic stenosis. A cardiac catherization also showed CAD, with signficant RCA disease for which he underwent stenting. (A): Echocardiogram (parasternal view) showing mild mitral annular calcification and severe aortic valve calcification. (B): Doppler shows moderate aortic stenosis with mild regurgitation.

Figure 4

Suggested algorithm for cardiovascular screening after mediastinal radiation therapy. Abbreviations: CT, computed tomography; ECG, electrocardiogram.