Radiation-associated cardiovascular toxicity

Late effects of radiation to the heart may include the following:[32-34] The risks to the heart are related to the amount of radiation delivered to different depths of the heart, volume and specific areas of the heart irradiated, total and fractional irradiation dose, age at exposure, and latency period.

Late effects of radiation to the heart may include the following:[32-34] The risks to the heart are related to the amount of radiation delivered to different depths of the heart, volume and specific areas of the heart irradiated, total and fractional irradiation dose, age at exposure, and latency period.

Delayed pericarditis.

Late effects of radiation to the heart may include the following:[32-34] The risks to the heart are related to the amount of radiation delivered to different depths of the heart, volume and specific areas of the heart irradiated, total and fractional irradiation dose, age at exposure, and latency period.

Pancarditis, including pericardial and myocardial fibrosis, with or without endocardial fibroelastosis.

Late effects of radiation to the heart may include the following:[32-34] The risks to the heart are related to the amount of radiation delivered to different depths of the heart, volume and specific areas of the heart irradiated, total and fractional irradiation dose, age at exposure, and latency period.

Cardiomyopathy.

Late effects of radiation to the heart may include the following:[32-34] The risks to the heart are related to the amount of radiation delivered to different depths of the heart, volume and specific areas of the heart irradiated, total and fractional irradiation dose, age at exposure, and latency period.

Coronary artery disease.[27,33]

Late effects of radiation to the heart may include the following:[32-34] The risks to the heart are related to the amount of radiation delivered to different depths of the heart, volume and specific areas of the heart irradiated, total and fractional irradiation dose, age at exposure, and latency period.

Functional valve injury.[27,35]

Late effects of radiation to the heart may include the following:[32-34] The risks to the heart are related to the amount of radiation delivered to different depths of the heart, volume and specific areas of the heart irradiated, total and fractional irradiation dose, age at exposure, and latency period.

Conduction defects.

Modern radiation techniques allow a reduction in the volume of cardiac tissue incidentally exposed to higher radiation doses. This reduction should lower the risk of adverse cardiac events.

Austrian-German investigators evaluated the development of cardiac disease (via patient self-report supplemented by physician report) in a cohort of 1,132 pediatric Hodgkin lymphoma survivors monitored for a median of 20 years. The 25-year cumulative incidence of heart disease increased with higher mediastinal radiation doses: 3% (unirradiated), 5% (20 Gy), 6% (25 Gy), 10% (30 Gy), and 21% (36 Gy). Valve defects were most common, followed by coronary artery disease, cardiomyopathy, rhythm disorders, and pericardial abnormalities.[35]

In a study of adult survivors of Hodgkin lymphoma, vigorous exercise lowered the risk of cardiovascular events, independent of the treatment received.[36]

Emerging data, not confined to patients with Hodgkin lymphoma but inclusive of other pediatric malignancies, suggest that a lower mean heart dose of 10 Gy to 15 Gy should be a goal in contemporary treatment protocols.[28]