Epidemiological data for radiation-related heart diseaseįollowing the use of mantle field radiation for Hodgkin lymphoma in the 1960s, RRHD was recognized because substantial cardiac damage was observed to occur after the whole heart received doses of radiation higher than 30 Gy. Although many cytotoxic and molecularly targeted drugs also result in various cardiac toxicities, consideration of these is outside the scope of this chapter.Ģ. We will also address the cardiac avoidance techniques and the dose-volume-effect relationship. In this chapter, we will present the epidemiological data and discuss the possible pathophysiological mechanisms in brief. However, thoracic RT might inadvertently result in various forms of cardiac toxicity and manifest as clinical and subclinical cardiac disease, termed radiation-related heart disease (RRHD). Many studies have proven that local RT improves local control and prolongs overall survival. Worldwide, lung, esophageal, and breast cancer account for approximately 27% of new cancer cases which means that more than 20% of patients will receive thoracic radiation therapy (RT). Lung cancer is the most common incident cancer and the leading cause of cancer death in China, and esophageal cancer is also commonly diagnosed. In China, in 2015, an estimated 4,292,000 new cancer cases and 2,814,000 cancer deaths occurred. Worldwide, the new cases or deaths from lung and breast cancer were at the top of the list. Currently, approximately 57% of cancer cases and 65% of cancer deaths occur in less developed countries. In 2012, an estimated 14.1 million new cancer cases and 8.2 million deaths occurred worldwide. The recognition, prediction, prevention, and management of RRHD require close collaboration between oncologists and cardiologists.Ĭancer is a leading cause of death in both developed and less developed countries worldwide, and its health burden is expected to increase rapidly. However, the standardized definitions of the cardiac structures, dose-volume limits during radiation planning design, the optimal dose-volume parameters, and the dose-volume effects of various cardiac substructures warrant further investigation. The treatment strategies of RRHD were based on the various recommended consensus of related heart diseases in cardiology. The total delivered radiation dose to cardiac implantable electronic devices was strongly recommended not to exceed 2 Gy. Advanced RT techniques, such as breath control, intensity-modulated RT, and image-guided RT, as well as limited target volume definition might spare or avoid cardiac doses and/or volume, which may translate into decreased incidence of RRHD. The main endpoints of RRHD include cardiac death from RT, clinical heart disease (congestive heart disease, ischemic heart disease, and myocardial infarction), and subclinical heart disease (cardiac perfusion defects). RT might inadvertently induce heart injury and result in various forms of radiation-related heart disease (RRHD). Approximately 25–30% of patients with cancer undergo thoracic radiation therapy (RT).
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