Radiation-induced heart disease: pathologic abnormalities and putative mechanisms.
Breast cancer is a common diagnosis in women. Breast radiation has become critical in managing patients who receive breast conserving surgery, or have certain high-risk features after mastectomy. Most patients have an excellent prognosis, therefore understanding the late effects of radiation to the chest is important. Radiation-induced heart disease (RIHD) comprises a spectrum of cardiac pathology including myocardial fibrosis and cardiomyopathy, coronary artery disease, valvular disease, pericardial disease, and arrhythmias. Tissue fibrosis is a common mediator in RIHD. Multiple pathways converge with both acute and chronic cellular, molecular, and genetic changes to result in fibrosis. In this article, we review the pathophysiology of cardiac disease related to radiation therapy to the chest. Our understanding of these mechanisms has improved substantially, but much work remains to further refine radiation delivery techniques and develop therapeutics to battle late effects of radiation.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center , New York, NY , USA.
Neil K
NK
Taunk
Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University , New Brunswick, NJ , USA.
Bruce G
BG
Haffty
Department of Medicine, The Cardiovascular Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University , New Brunswick, NJ , USA.
John B
JB
Kostis
Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University , New Brunswick, NJ , USA.
Sharad
S
Goyal
breast cancer; radiation fibrosis; radiation side effects; radiation therapy