Systematic Review/Meta-analysisLong-term Risk of Heart Failure and Myocardial Dysfunction After Thoracic Radiotherapy: A Systematic Review
Section snippets
Methods
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting the systematic review.12 The search strategy was designed prospectively. PubMed and EMBASE were searched from inception to July 2015. Exact search terms used are listed in Supplemental Appendix S1. Citations and details were stored in a database (EndNote X7.4, Thomson Reuters, New York, NY).
Study selection
From the original screening set of 7329 articles, 768 were deemed suitable for abstract review, to which a further 3 articles were added from bibliographic review of review articles (Fig 1). Of the 768 abstracts reviewed, 176 were selected for full review, of which 38 contributed data to this analysis.
Mediastinal irradiation for HD
Twenty-one studies (1659 patients) were identified as those that fit the inclusion criteria for investigation of long-term ventricular function after mediastinal irradiation for HD. Sixteen
Discussion
The studies selected for this systematic review showed a large degree of heterogeneity, in terms of study characteristics and findings. Notably, a large number of studies (17 of 40) were published > 20 years ago, and many consisted of cohorts with small numbers of patients. It was therefore difficult to reach definitive conclusions regarding the etiology and presentation of radiation-induced myocardial disease, despite that RT has been used as a therapeutic modality for almost a century.
Conclusions
With successful advances in contemporary cancer treatment, clinical challenges are slowly pivoting from increasing 5-year survival to managing chronic health conditions in cancer survivors. This vulnerable population requires further research to identify strategies for identifying patients at high risk for RT-induced myocardial disease and provision of early and effective treatment.
Funding Sources
Funded in part by a Health Professional scholarship from the Heart Foundation Australia.
Disclosures
The authors have no conflicts of interest to disclose.
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2018, International Journal of SurgeryCitation Excerpt :Nonmalignant death usually occurs in long-term cancer survivors. Radiation-induced cardiovascular disease (RICVD) is the most common nonmalignant cause of death in chest-irradiated cancer survivors, such as patients with Hodgkin's lymphoma (HL) and breast cancer, and a clear association exists between high thoracic radiation dose and increased risk of cardiovascular disease (CVD) [6–10]. For patients with thymoma, advances in treatment have increased the number of long-term survivors.
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2017, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :However, there is insufficient knowledge on cardiomyopathy. A recent meta-analysis on the long-term risk of HF and myocardial dysfunction after thoracic RT found that thoracic RT is associated with an increased incidence of HF (hazard ratios of 1.5-2.4) following RT for breast cancer (42). At present, there are inconsistent recommendations or guidelines on the screening and follow-up of patients after RT.
Cardio-Oncology – A new subspecialty with collaboration at its heart
2017, Indian Heart JournalCitation Excerpt :It should however be emphasized that while the PRADA trial has provided helpful data, it is a small trial and meta-analyses have shown the benefit of beta-blockers in Cardio-Oncology patients.28 It is important to remember that radiotherapy in cancer patients can cause wide-ranging cardiac damage including heart failure.31–33 Radio-therapy-induced cardiac damage was more common earlier but modern techniques such as focussed beam radiotherapy and better shielding have decreased the prevalence.34
Radiotherapy-induced right ventricular remodelling: The missing piece of the puzzle
2017, Archives of Cardiovascular DiseasesCitation Excerpt :Furthermore, the majority of patients with cancer are treated not only with radiotherapy, but also with chemotherapy, which is known to be a strong independent predictor of adverse cardiac remodelling, further increasing the necessity for careful cardiac assessment of patients with cancer. The primary focus of investigations into RIHD has been the left ventricle (LV) [3,6], which is why current guidelines regarding cancer treatment and cardiovascular toxicity concentrate mainly on left ventricular (LV) assessment [7,8]. Data regarding radiotherapy-induced right ventricular (RV) remodelling are scarce and, in most studies, patients were also treated with chemotherapy, which makes the assessment of isolated radiotherapy-induced RV remodelling more difficult [9–12].
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