open access

Vol 24, No 6 (2019)
Reviews
Published online: 2019-11-01
Submitted: 2019-03-15
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Cardiotoxicity of mediastinal radiotherapy

Ivica Ratosa, Maja Ivanetic Pantar
DOI: 10.1016/j.rpor.2019.09.002
·
Rep Pract Oncol Radiother 2019;24(6):629-643.

open access

Vol 24, No 6 (2019)
Reviews
Published online: 2019-11-01
Submitted: 2019-03-15

Abstract

Aim

To explore available recent literature related to cardiotoxicity following mediastinal radiation.

Background

Radiotherapy-related heart injury is well documented, with no apparent safety threshold dose. The number of long-term cancer survivors exposed to mediastinal radiotherapy at some point of their treatment is increasing. Heart dosimetric parameters are of great importance in developing a treatment plan, but few data are available regarding radiosensitivity and dose-volume constraints for specific heart structures.

Materials and Methods

In October 2018, we identified articles published after 1990 through a PubMed/MEDLINE database search. The authors examined rough search results and manuscripts not relevant for the topic were excluded. We extracted clinical outcomes following mediastinal radiotherapy of childhood cancers, lymphoma, medulloblastoma, thymic cancers and hematopoietic cell transplantation survivors and evaluated treatment planning data, whenever available.

Results

A total of 1311 manuscripts were identified in our first-round search. Of these manuscripts, only 115 articles, matching our selection criteria, were included.

Conclusions

Studies uniformly show a linear radiation dose-response relationship between mean absorbed dose to the heart (heart-Dmean) and the risk of dying as a result of cardiac disease, particularly when heart-Dmean exceeds 5Gy. Limited data are available regarding dose-volume predictors for heart substructures and the risk of subsequent cardiac toxicity. An individual patient’s cardiotoxicity risk can be modified with advanced treatment planning techniques, including deep inspiration breath hold. Proton therapy is currently showing advantages in improving treatment planning parameters when compared to advanced photon techniques in lymphoma, thymic malignancies, malignant mesothelioma and craniospinal irradiation.

Abstract

Aim

To explore available recent literature related to cardiotoxicity following mediastinal radiation.

Background

Radiotherapy-related heart injury is well documented, with no apparent safety threshold dose. The number of long-term cancer survivors exposed to mediastinal radiotherapy at some point of their treatment is increasing. Heart dosimetric parameters are of great importance in developing a treatment plan, but few data are available regarding radiosensitivity and dose-volume constraints for specific heart structures.

Materials and Methods

In October 2018, we identified articles published after 1990 through a PubMed/MEDLINE database search. The authors examined rough search results and manuscripts not relevant for the topic were excluded. We extracted clinical outcomes following mediastinal radiotherapy of childhood cancers, lymphoma, medulloblastoma, thymic cancers and hematopoietic cell transplantation survivors and evaluated treatment planning data, whenever available.

Results

A total of 1311 manuscripts were identified in our first-round search. Of these manuscripts, only 115 articles, matching our selection criteria, were included.

Conclusions

Studies uniformly show a linear radiation dose-response relationship between mean absorbed dose to the heart (heart-Dmean) and the risk of dying as a result of cardiac disease, particularly when heart-Dmean exceeds 5Gy. Limited data are available regarding dose-volume predictors for heart substructures and the risk of subsequent cardiac toxicity. An individual patient’s cardiotoxicity risk can be modified with advanced treatment planning techniques, including deep inspiration breath hold. Proton therapy is currently showing advantages in improving treatment planning parameters when compared to advanced photon techniques in lymphoma, thymic malignancies, malignant mesothelioma and craniospinal irradiation.

Get Citation

Keywords

RR; Dmean; Dmax; NTCP; HR; OR; Vx; IMRT; 2D-RT; 3D-CRT; G; Gy; EQD2; VMAT; HT; CSI; CI; CVD; TBI; PTV; Mv; OAR; ISRT; INRT; IFRT; LAD; Cardiotoxicity; Mediastinal radiotherapy; Mediastinal tumours; Dose-volume predictors; Normal tissue complication probability

About this article
Title

Cardiotoxicity of mediastinal radiotherapy

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 24, No 6 (2019)

Pages

629-643

Published online

2019-11-01

DOI

10.1016/j.rpor.2019.09.002

Bibliographic record

Rep Pract Oncol Radiother 2019;24(6):629-643.

Keywords

RR
Dmean
Dmax
NTCP
HR
OR
Vx
IMRT
2D-RT
3D-CRT
G
Gy
EQD2
VMAT
HT
CSI
CI
CVD
TBI
PTV
Mv
OAR
ISRT
INRT
IFRT
LAD
Cardiotoxicity
Mediastinal radiotherapy
Mediastinal tumours
Dose-volume predictors
Normal tissue complication probability

Authors

Ivica Ratosa
Maja Ivanetic Pantar

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