I stumbled on an interesting Twitter thread on effects of XRT on heart. They are mutlifactorial and no effective pharmacotherapy exists. Therefore, the onus is on the medical oncologists (to devise effective “less-cardiotoxic” therapies) and on radiation oncologists to devise effective delivery mechanisms without an obvious increase of the side effects. It is an exciting, evolving field and after much deliberation, I am sharing three papers here. For copyright reasons, I can’t include them on the blog, but there is a persistent Paperpile link (hopefully, you should be able to see the annotations made there). I am including the summaries.
The first paper is by Kiorva et al. This has practical suggestions on reduction of dosage and is highly recommended read:
Kirova, Y., A. Tallet, M. C. Aznar, P. Loap, A. Bouali, and C. Bourgier. 2020. “Radio-Induced Cardiotoxicity: From Physiopathology and Risk Factors to Adaptation of Radiotherapy Treatment Planning and Recommended Cardiac Follow-Up.” Cancer Radiotherapie: Journal de La Societe Francaise de Radiotherapie Oncologique 24 (6-7): 576–85. https://doi.org/10.1016/j.canrad.2020.07.001.
[embeddoc url=”https://radoncnotescom.files.wordpress.com/2022/01/f9b86-kirova-et-al.docx”%5DThe second paper is by Desai et al – it discusses the history of evolution of radiation therapy and impact on the heart with further management.
Desai, Milind Y., Stephan Windecker, Patrizio Lancellotti, Jeroen J. Bax, Brian P. Griffin, Oren Cahlon, and Douglas R. Johnston. 2019. “Prevention, Diagnosis, and Management of Radiation-Associated Cardiac Disease: JACC Scientific Expert Panel.” Journal of the American College of Cardiology 74 (7): 905–27. https://doi.org/10.1016/j.jacc.2019.07.006.
[embeddoc url=”https://radoncnotescom.files.wordpress.com/2022/01/395d3-desai-et-al.docx”%5DThe third paper by Wang et al discusses the pathogenetic mechanisms of XRT and is a highly recommended read on acute/chronic effects of radiation (including the clinical syndrome of CAD and accelerated atherosclerosis). This too is a highly recommended read.
Wang, Heru, Jinlong Wei, Qingshuang Zheng, Lingbin Meng, Ying Xin, Xia Yin, and Xin Jiang. 2019. “Radiation-Induced Heart Disease: A Review of Classification, Mechanism and Prevention.” International Journal of Biological Sciences 15 (10): 2128–38. https://doi.org/10.7150/ijbs.35460.
[embeddoc url=”https://radoncnotescom.files.wordpress.com/2022/01/ff0e8-wang-et-al.docx”%5DYou can access the library of papers from here This should open up the shared folder with attached PDF’s. Happy reading!
RadOncNotes 