Cancer Research on Prevention and Treatment    2018, Vol. 45 Issue (11) : 847-851     DOI: 10.3971/j.issn.1000-8578.2018.18.0887
Technical Prevention of Radiation-induced Cardiovascular Toxicity
WANG Xuanyi, YU Xiaoli
Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Download: PDF(2921 KB)   ( 94 )   HTML ()
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks
Abstract Radiotherapy has been an important component of cancer treatment. In the malignancy with long survival, radiation-induced cardiovascular toxicity significantly jeopardize patients’ outcome. Despite that its pathophysiological mechanism is not clear yet, many studies have confirmed the positive correlation between cardiovascular involvement dose, irradiated volume and radiation-induced cardiotoxicity. Therefore, reducing cardiovascular involvement dose as well as irradiated volume is the key to cardiac sparing techniques in radiotherapy. Cardiac sparing techniques includes: (1) methods that reduce radiation fields and dose; (2) methods that increase the distance between heart and irradiated fields; (3) new techniques such as intensity modulated radiotherapy and proton therapy. Although researches in dosimetry have showed that cardiac sparing techniques could lower cardiovascular involvement dose and irradiated volume, further validation is needed for curative effect.
Keywords Radiotherapy      Radiation-induced cardiovascular toxicity      Cardiac sparing technique     
ZTFLH:  R732  
Issue Date: 14 November 2018
 Cite this article:   
WANG Xuanyi,YU Xiaoli. Technical Prevention of Radiation-induced Cardiovascular Toxicity[J]. Cancer Research on Prevention and Treatment, 2018, 45(11): 847-851.
E-mail this article
E-mail Alert
Articles by authors
WANG Xuanyi
YU Xiaoli
[1] McGale P, Darby SC, Hall P, et al. Incidence of heart disease
in 35,000 women treated with radiotherapy for breast cancer in
Denmark and Sweden[J]. Radiother oncol, 2011, 100(2): 167-75.
[2] Clarke M, Collins R, Darby S, 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[J]. Lancet, 2005, 366(9503): 2087-106.
[3] Mulrooney DA, Yeazel MW, Kawashima T, et al. Cardiac
outcomes in a cohort of adult survivors of childhood and
adolescent cancer: retrospective analysis of the Childhood Cancer
Survivor Study cohort[J]. BMJ, 2009, 339: b4606.
[4] Stewart JR, Fajardo LF. Radiation-induced heart disease: an
update[J]. Prog Cardiovasc Dis, 1984, 27(3): 173-94.
[5] Fajardo LF, Stewart JR. Capillary injury preceding radiationinduced
myocardial fibrosis[J]. Radiology, 1971, 101(2): 429-33.
[6] Gabriels K, Hoving S, Seemann I, et al. Local heart irradiation of
ApoE(-/-) mice induces microvascular and endocardial damage
and accelerates coronary atherosclerosis[J]. Radioth Oncol, 2012,
105(3): 358-64.
[7] Lee MS, Finch W, Mahmud E. Cardiovascular complications of
radiotherapy[J]. Am J Cardiol, 2013, 112(10): 1688-96.
[8] Darby SC, Ewertz M, McGale P, et al. Risk of Ischemic Heart
Disease in Women after Radiotherapy for Breast Cancer[J]. N
Engl J Med, 2013, 368(11): 987-98.
[9] Harris EE, Correa C, Hwang WT, et al. Late cardiac mortality
and morbidity in early-stage breast cancer patients after breastconservation
treatment[J]. J Clin Oncol, 2006, 24(25): 4100-6.
[10] Maraldo MV, Giusti F, Vogelius IR, et al. Cardiovascular disease
after treatment for Hodgkin’s lymphoma: an analysis of nine
collaborative EORTC-LYSA trials[J]. Lancet Haematol, 2015,
2(11): e492-502.
[11] Cutter DJ, Schaapveld M, Darby SC, et al. Risk of valvular heart
disease after treatment for Hodgkin lymphoma[J]. J Natl Cancer
Inst, 2015, 107(4): pii: djv008.
[12] Fukada J, Shigematsu N, Takeuchi H, et al. Symptomatic
pericardial effusion after chemoradiation therapy in esophageal
cancer patients[J]. Int J Radiat Oncol Biol Phys, 2013, 87(3):
[13] Ning MS, Tang L, Gomez DR, et al. Incidence and predictors
of pericardial effusion after chemoradiation therapy for locally
advanced non-small cell lung cancer[J]. Int J Radiat Oncol Biol
Phys, 2017, 99(1): 70-9.
[14] Ogino I, Watanabe S, Iwahashi N, et al. Symptomatic radiationinduced
cardiac disease in long-term survivors of esophageal
cancer[J]. Strahlenther Onkol, 2016, 192(6): 359-67.
[15] Taylor CW, Wang Z, Macaulay E, et al. Exposure of the Heart in
Breast Cancer Radiation Therapy: A Systematic Review of Heart
Doses Published During 2003 to 2013[J]. Int J Radiat Oncol Biol
Phys, 2015, 93(4): 845-53.
[16] Hiatt JR, Evans SB, Price LL, et al. Dose-modeling study
to compare external beam techniques from protocol NSABP
B-39/RTOG 0413 for patients with highly unfavorable cardiac
anatomy[J]. Int J Radiat Oncol Biol Phys, 2006, 65(5): 1368-74.
[17] Appelt AL, Vogelius IR, Bentzen SM. Modern hypofractionation
schedules for tangential whole breast irradiation decrease the
fraction size-corrected dose to the heart[J]. Clin Oncol (R Coll
Radiol), 2013, 25(3): 147-52.
[18] Maraldo MV, Brodin NP, Vogelius IR, et al. Risk of developing
cardiovascular disease after involved node radiotherapy versus
mantle field for Hodgkin lymphoma[J]. Int J Radiat Oncol Biol
Phys, 2012, 83(4): 1232-7.
[19] Joo JH, Kim SS, Ahn SD, et al. Cardiac dose reduction during
tangential breast irradiation using deep inspiration breath hold: a
dose comparison study based on deformable image registration[J].
Radiat Oncol, 2015, 10: 264.
[20] Mohamad O, Shiao J, Zhao B, et al. Deep inspiration breathhold
for left-sided breast cancer patients with unfavorable cardiac
anatomy requiring internal mammary nodal irradiation[J]. Pract
Radiat Oncol, 2017, 7(6): e361-7.
[21] Mulliez T, Van de Velde J, Veldeman L, et al. Deep inspiration
breath hold in the prone position retracts the heart from the breast
and internal mammary lymph node region[J]. Radiother Oncol,
2015, 117(3): 473-6.
[22] Deseyne P, Speleers B, De Neve W, et al. Whole breast and
regional nodal irradiation in prone versus supine position in left
sided breast cancer[J]. Radiat Oncol, 2017, 12(1): 89.
[23] Beckham WA, Popescu CC, Patenaude VV, et al. Is multibeam
IMRT better than standard treatment for patients with left-sided
breast cancer?[J]. Int J Radiat Oncol Biol Phys, 2007, 69(3): 918-24.
[24] Xie X, Ouyang S, Wang H, et al. Dosimetric comparison of leftsided
whole breast irradiation with 3D-CRT, IP-IMRT and hybrid
IMRT[J]. Oncol Rep, 2014, 31(5): 2195-205.
[25] Xu D, Li G, Li H, et al. Comparison of IMRT versus 3D-CRT in
the treatment of esophagus cancer: A systematic review and metaanalysis[
J]. Medicine (Baltimore), 2017, 96(31): e7685.
[26] Lin LL, Vennarini S, Dimofte A, et al. Proton beam versus photon
beam dose to the heart and left anterior descending artery for leftsided
breast cancer[J]. Acta Oncol, 2015, 54(7): 1032-9.
[27] Mast ME, Vredeveld EJ, Credoe HM, et al. Whole breast proton
irradiation for maximal reduction of heart dose in breast cancer
patients[J]. Breast Cancer Res Treat, 2014, 148(1): 33-9.
[28] Wu SZ, Tao LY, Wang JN, et al. Amifostine pretreatment
attenuates myocardial ischemia/reperfusion injury by inhibiting
apoptosis and oxidative stress[J]. Oxid Med Cell Longev, 2017,
2017: 4130824.
[29] Qian L, Cao F, Cui J, et al. The Potential Cardioprotective Effects
of Hydrogen in Irradiated Mice[J]. J Radiat Res, 2010, 51(6):
[30] Zhang ZY, Li Y, Li R, et al. Tetrahydrobiopterin Protects against
Radiation-induced Growth Inhibition in H9c2 Cardiomyocytes[J].
Chin Med J (Engl), 2016, 129(22): 2733-40.
[31] Fan Z, Han Y, Ye Y, et al. l-carnitine preserves cardiac function
by activating p38 MAPK/Nrf2 signalling in hearts exposed to
irradiation[J]. Eur J Pharmacol, 2017, 804: 7-12.
Related articles from Frontiers Journals
[1] ZHAO Qi, LIU Zhuang. Recent Progress in Nano-biomaterials for Tumor Hypoxia Relief and Enhanced Cancer Radiotherapy[J]. Cancer Research on Prevention and Treatment, 2021, 48(02): 109-114.
[2] WANG Sheng, WANG Cailian, FAN Lihua. Correlation Between Dose Volume Parameters and Radiation Pneumonitis in Elderly Patients with Esophageal Cancer After Three-dimensional Conformal Radiotherapy[J]. Cancer Research on Prevention and Treatment, 2021, 48(02): 173-177.
[3] ZHANG Qiang, WU Shaoya, ZHANG Jing. New Insight on Tumor Microenvironment Remodelling and Augmented Therapeutic Efficacy of Immunotherapy by Radiotherapy[J]. Cancer Research on Prevention and Treatment, 2021, 48(01): 1-6.
[4] HUANG Dingfeng, YANG Jie, LEI Li, SONG Aimei. Prevention and Control Management of Patients Undergoing Radiotherapy in Cancer Hospitals During COVID-19 Epidemic[J]. Cancer Research on Prevention and Treatment, 2020, 47(09): 684-687.
[5] WEI Xueyan, LI Ying, HU Desheng. Nutritional Status and Its Influencing Factors of Nasopharyngeal Carcinoma Patients During Chemoradiotherapy[J]. Cancer Research on Prevention and Treatment, 2020, 47(07): 524-530.
[6] LUO Huachun, FU Zhichao, FENG Jing, SHEN Zhiyong, YING Wenmin, CAI Lyujuan, CHENG Huihua. Clinical Characteristics and Influencing Factors of Esophageal Squamous Cell Carcinoma Patients with Brain Metastases and Their Influence on Survival[J]. Cancer Research on Prevention and Treatment, 2020, 47(06): 437-440.
[7] CAI Jing, XIONG Qiang, WEI Jianping, LIU Anwen. Efficacy of Magnetic Resonance IVIM Imaging in Guiding Target Delineation and Dose Escalation of Concurrent Radiochemotherapy on Locally Advanced NSCLC[J]. Cancer Research on Prevention and Treatment, 2020, 47(05): 381-386.
[8] HE Qian, REN Qinglan. Research Advances in Intracranial Radiotherapy Combined with Immune Checkpoint Inhibitors on Lung Cancer Brain Metastasis[J]. Cancer Research on Prevention and Treatment, 2020, 47(04): 303-308.
[9] CHEN Jihui, LIN Wei, JING Hang, SONG Haiping, MA Xuezhen. Dosimetric Comparison Between VMAT with Different Arc and dIMRT for Early-stage Peripheral Lung Adenocarcinoma[J]. Cancer Research on Prevention and Treatment, 2019, 46(12): 1091-1096.
[10] DENG Kangli, CUI Diansheng, LUO Bo, JIA Quan'an, LIU Sanhe, HUANG Lei, ZHU Hui, WEI Shaozhong. Efficacy of Definitive External-beam Radiotherapy Versus Radical Prostatectomy on Clinically Localized High-risk Prostate Cancer Patients: A Retrospective Study[J]. Cancer Research on Prevention and Treatment, 2019, 46(12): 1113-1117.
[11] ZHOU Xingqin, ZHAO Hongyu, SONG Yao, CHEN Wenjuan, SHEN Chaoyan, JI Bin. Therapeutic Effect of Elemene Combined with Chemoradiotherapy and Its Influence on Immune Function in Nasopharyngeal Carcinoma Patients[J]. Cancer Research on Prevention and Treatment, 2019, 46(12): 1118-1122.
[12] JIANG Hongqing, LIU Ping, LIU Zhihui. Comparison of Survival and Postoperative Complication of Stage Ⅰb2-Ⅱa2 Cervical Cancer Patients Among Three Kinds of Therapeutic Regimens[J]. Cancer Research on Prevention and Treatment, 2019, 46(09): 825-828.
[13] ZHANG Li. Progress on Comprehensive Treatment of Nasopharyngeal Cancer[J]. Cancer Research on Prevention and Treatment, 2019, 46(08): 667-671.
[14] TAO Fang, WANG Guowen, HAN Xiuxin, MA Yulin, ZHANG Chao, LI Lili. Prognostic Factors and Comprehensive Treatment of 95 Synovial Sarcoma Patients[J]. Cancer Research on Prevention and Treatment, 2019, 46(06): 519-525.
[15] SHEN Wenbin, Guo Na, ZHU Shuchai, CAO Yankun, LI Shuguang, XU Jinrui. Effect of Selective Increase of Single Dose of PTV on Prognosis of Patients with Esophageal Cancer[J]. Cancer Research on Prevention and Treatment, 2019, 46(05): 463-469.
Full text