1
|
Han X, Yang X, Hidru TH, Wang C, Xia Y. Patterns of Anticoagulation Use and All-Cause of Mortality in Cancer Patients with Atrial Fibrillation. Cancer Epidemiol Biomarkers Prev 2024; 33:244-253. [PMID: 38088911 DOI: 10.1158/1055-9965.epi-23-0866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/23/2023] [Accepted: 11/13/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND There is uncertainty regarding the clinical benefit of anticoagulant (AC) treatment in patients with cancer with atrial fibrillation (AF). We aimed to evaluate the distribution and patterns of AC use and its impact on all-cause mortality in cancer patients with AF. METHODS A total of 1,653 patients with cancer diagnosed with AF were included in this retrospective cohort analysis. Multivariable logistic regression was applied to identify the clinical predictors of anticoagulant prescription. Kaplan-Meier curve with a log-rank test was used to compare the probability of survival between the AC and non-AC groups. Multivariate Cox proportional hazard regression models were implemented to evaluate the influences of various variables on all-cause death. RESULTS Of 1,653 patients with cancer with AF, 971 (58.7%) did not receive a prescription for AC. Among patients with CHA2DS2-VASC ≥2 in men or ≥3 in women and HAS-BLED <3, 56.5% were not prescribed AC. Rivaroxaban and warfarin are more frequently used than dabigatran, mainly in patients with lung and breast cancer. Over a median follow-up of 36 months, 776 deaths were identified. The Kaplan-Meier curve suggested that patients with AC prescriptions had better clinical outcomes. On multivariate Cox proportional risk regression analysis, AC prescription was significantly associated with a lower risk of all-cause mortality (hazard ratio, 0.78; 95% confidence interval, 0.66-0.91; P = 0.002). CONCLUSIONS The prescription of anticoagulants in patients with cancer with AF was suboptimal. AC prescription at discharge was associated with a decreased risk of all-cause mortality. IMPACT This study highlights the importance of AC prescriptions in patients with cancer with AF.
Collapse
Affiliation(s)
- Xu Han
- Health Management Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiaolei Yang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Tesfaldet H Hidru
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Chengfang Wang
- Health Management Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunlong Xia
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| |
Collapse
|
2
|
Peix A, Perez A, Barreda AM. Cancer and Postradiotherapy Cardiotoxicity: How to Face Damage in Women’s Hearts? Eur Cardiol 2023. [DOI: 10.15420/ecr.2022.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Cancer and cardiovascular disease are the two main causes of death worldwide in both men and women. In the past decades, survival rate in cancer patients has substantially improved due to new treatments and developments in radiation therapy (RT). In women, breast cancer (BC) is the leading cause of cancer death and thoracic RT is a main component of the treatment in many cases. Nevertheless, despite new techniques that limit the area receiving RT, cardiac damage is still an important concern in BC patients. In this review, the following aspects will be addressed: pathophysiology of postradiotherapy heart damage in women with BC; mechanisms, diagnosis and prevention/management of heart damage; and future areas of potential research for radiotherapy injury in women.
Collapse
|
3
|
Yin H, Zhao Y, Sun Y, Liu J, Han Y, Dai Z. Effectiveness of Proanthocyanidin plus Trimetazidine in the Treatment of Non-Small-Cell Lung Cancer with Radiation Heart Injury. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2338622. [PMID: 35692580 PMCID: PMC9187471 DOI: 10.1155/2022/2338622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 12/11/2022]
Abstract
This study was intended to explore the effect of proanthocyanidin (PC) combined with trimetazidine in non-small-cell lung cancer (NSCLC) with radiation-induced heart damage (RIHD). It was a prospective randomized controlled study that 86 NSCLC patients with radiation treatment in Cangzhou People's Hospital from January 2019 and June 2021 were enrolled and randomized to either the control group or the study group via the random table method, 43 cases in each group. The control group received trimetazidine, and the study group additionally received PC. The incidence of RIHD-related clinical manifestation, RIHD-related ECG, and RIHD-related cardiac ultrasound change were all lower in the study group. After radiotherapy, the serum level of superoxide dismutase (SOD) was higher, and malondialdehyde (MDA) was lower in the study group when compared with the control group. After radiotherapy, the serum levels of brain natriuretic peptide (BNP), cardiac troponin (cTnT), creatine kinase (CK), and creatine kinase isoenzymes (CKMB) were all lower in the study group when compared with the control group. The efficacy of PC plus trimetazidine for NSCLC with RIHD is superior to trimetazidine alone, and it significantly mitigates radiation-induced inflammatory response and oxidative stress.
Collapse
Affiliation(s)
- Hang Yin
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Yue Zhao
- Department II of Radiotherapy, Cangzhou Central Hospital, Cangzhou, China
| | - Yucui Sun
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Jia Liu
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Yingjun Han
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Zhentao Dai
- Ward I, Department of Cardiovascular Medicine, Cangzhou People's Hospital, Cangzhou, China
| |
Collapse
|
4
|
Latrèche A, Bourbonne V, Lucia F. Unrecognized thoracic radiotherapy toxicity: A review of literature. Cancer Radiother 2022; 26:616-621. [DOI: 10.1016/j.canrad.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
|
5
|
Sallam M, Benotmane MA, Baatout S, Guns PJ, Aerts A. Radiation-induced cardiovascular disease: an overlooked role for DNA methylation? Epigenetics 2022; 17:59-80. [PMID: 33522387 PMCID: PMC8812767 DOI: 10.1080/15592294.2021.1873628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/27/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
Radiotherapy in cancer treatment involves the use of ionizing radiation for cancer cell killing. Although radiotherapy has shown significant improvements on cancer recurrence and mortality, several radiation-induced adverse effects have been documented. Of these adverse effects, radiation-induced cardiovascular disease (CVD) is particularly prominent among patients receiving mediastinal radiotherapy, such as breast cancer and Hodgkin's lymphoma patients. A number of mechanisms of radiation-induced CVD pathogenesis have been proposed such as endothelial inflammatory activation, premature endothelial senescence, increased ROS and mitochondrial dysfunction. However, current research seems to point to a so-far unexamined and potentially novel involvement of epigenetics in radiation-induced CVD pathogenesis. Firstly, epigenetic mechanisms have been implicated in CVD pathophysiology. In addition, several studies have shown that ionizing radiation can cause epigenetic modifications, especially DNA methylation alterations. As a result, this review aims to provide a summary of the current literature linking DNA methylation to radiation-induced CVD and thereby explore DNA methylation as a possible contributor to radiation-induced CVD pathogenesis.
Collapse
Affiliation(s)
- Magy Sallam
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
- Laboratory of Physiopharmacology, University of Antwerp, Wilrijk, Belgium
| | - Mohammed Abderrafi Benotmane
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Sarah Baatout
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
- Department of Molecular Biotechnology, Ghent University, Ghent, Belgium
| | - Pieter-Jan Guns
- Laboratory of Physiopharmacology, University of Antwerp, Wilrijk, Belgium
| | - An Aerts
- Radiobiology Unit, Institute for Environment, Health and Safety, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| |
Collapse
|
6
|
Sase K, Fujisaka Y, Shoji M, Mukai M. Cardiovascular Complications Associated with Contemporary Lung Cancer Treatments. Curr Treat Options Oncol 2021; 22:71. [PMID: 34110522 DOI: 10.1007/s11864-021-00869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT Lung cancer is the most common form of cancer in humans and the leading cause of cancer-related death worldwide. Traditionally, lung cancer has been diagnosed as either small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC). However, recent developments in molecular pathology have revolutionized the diagnosis and treatment of the disease, thus improving patient prognosis and increasing the number of survivors. In advanced NSCLC cases, molecularly targeted drugs for patients with positive driver gene mutation/rearrangement, and immune checkpoint inhibitors for those with a positive biomarker, have changed the standard of care. SCLC is a highly malignant entity. In addition to the chemotherapy and radiotherapy, immune checkpoint inhibitors have recently provided some hope for extended-stage SCLC. Smoking cessation is related to decreased morbidity. However, early metastasis remains a significant challenge. Recently, cancer therapy-related cardiovascular disease (CTRCD) has emerged as diverse pathophysiology, including fulminant myocarditis, fatal arrhythmia, pericarditis, hypertension, and thrombosis, that emerged with modern lung cancer therapies. Cardio-oncology is a new interdisciplinary collaboration to develop methodologies to manage cardiovascular risk factors and CTRCDs with the common goal of minimizing unnecessary interruption of cancer treatment and maximizing outcomes of lung cancer survivors.
Collapse
Affiliation(s)
- Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University, Tokyo, Japan.
| | - Yasuhito Fujisaka
- Department of Respiratory Medicine and Thoracic Oncology/Clinical Research Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Masaaki Shoji
- Department of General Internal Medicine/Oncologic Emergencies, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mikio Mukai
- Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Department of Medical Check-up, Osaka, Japan
| |
Collapse
|
7
|
Estratificación, monitorización y control del riesgo cardiovascular en pacientes con cáncer. Documento de consenso de SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC y AECC. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
8
|
Díaz-Gavela AA, Figueiras-Graillet L, Luis ÁM, Salas Segura J, Ciérvide R, del Cerro Peñalver E, Couñago F, Arenas M, López-Fernández T. Breast Radiotherapy-Related Cardiotoxicity. When, How, Why. Risk Prevention and Control Strategies. Cancers (Basel) 2021; 13:1712. [PMID: 33916644 PMCID: PMC8038596 DOI: 10.3390/cancers13071712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/24/2022] Open
Abstract
In recent decades, improvements in breast cancer management have increased overall patient survival; however, many cancer therapies have been linked to an important risk of cardiovascular adverse events. Cardio-oncology has been proposed as an emerging specialty to coordinate preventive strategies that improve the cardiovascular health of oncologic patients. It employs the most suitable personalized multidisciplinary management approach for each patient to optimize their cardiovascular health and improve their survival and quality of life. Radiotherapy is an essential part of the therapeutic regimen in breast cancer patients but can also increase the risk of cardiovascular disease. Therefore, minimizing the negative impact of radiation therapy is an important challenge for radiotherapy oncologists and cardiologists specializing in this field. The aim of the present review is to update our knowledge about radiation-induced cardiotoxicity in breast cancer patients by undertaking a critical review of the relevant literature to determine risk prevention and control strategies currently available.
Collapse
Affiliation(s)
- Ana Aurora Díaz-Gavela
- Radiation Oncology, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain;
- Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Lourdes Figueiras-Graillet
- Cardiooncology Clinic, Centro Estatal de Cancerología Miguel Dorantes Mesa, Xalapa-Enríquez 91130, Mexico;
| | - Ángel Montero Luis
- Radiation Oncology Department, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain; (Á.M.L.); (R.C.)
| | - Juliana Salas Segura
- Cardio-oncology Unit, Hospital San Juan de Dios, San José 10103, Costa Rica;
- Cardiology Department, Hospital Clínica Bíblica. San José 10103, Costa Rica
| | - Raquel Ciérvide
- Radiation Oncology Department, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain; (Á.M.L.); (R.C.)
| | - Elia del Cerro Peñalver
- Radiation Oncology, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain;
- Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Felipe Couñago
- Radiation Oncology, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain;
- Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Meritxell Arenas
- Radiation Oncology, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain;
- Universitat Rovira i Virgili. IISPV, 43204 Reus, Spain
| | - Teresa López-Fernández
- Cardio-oncology Unit. Cardiology Department, Hospital Universitario La Paz, 28046 Madrid, Spain;
- Hospital La Paz Institute for Health Research—IdiPAZ, 28046 Madrid, Spain
| |
Collapse
|
9
|
Martín García A, Mitroi C, Mazón Ramos P, García Sanz R, Virizuela JA, Arenas M, Egocheaga Cabello I, Albert D, Anguita Sánchez M, Arrarte Esteban VI, Ayala de la Peña F, Bonanand Lozano C, Castro A, Castro Fernández A, Córdoba R, Cosín-Sales J, Chaparro-Muñoz M, Dalmau R, Drak Hernández Y, Deiros Bronte L, Díez-Villanueva P, Escobar Cervantes C, Fernández Redondo C, García Rodríguez E, Lozano T, Marco Vera P, Martínez Monzonis A, Mesa D, Oristrell G, Palma Gámiz JL, Pedreira M, Reinoso-Barbero L, Rodríguez I, Serrano Antolín JM, Toral B, Torres Royo L, Velasco Del Castillo S, Vicente-Herrero T, Zatarain-Nicolás E, Tamargo J, López Fernández T. Stratification and management of cardiovascular risk in cancer patients. A consensus document of the SEC, FEC, SEOM, SEOR, SEHH, SEMG, AEEMT, AEEC, and AECC. ACTA ACUST UNITED AC 2021; 74:438-448. [PMID: 33712348 DOI: 10.1016/j.rec.2020.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Both cancer treatment and survival have significantly improved, but these advances have highlighted the deleterious effects of vascular complications associated with anticancer therapy. This consensus document aims to provide a coordinated, multidisciplinary and practical approach to the stratification, monitoring and treatment of cardiovascular risk in cancer patients. The document is promoted by the Working Group on Cardio Oncology of the Spanish Society of Cardiology (SEC) and was drafted in collaboration with experts from distinct areas of expertise of the SEC and the Spanish Society of Hematology and Hemotherapy (SEHH), the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Radiation Oncology (SEOR), the Spanish Society of General and Family Physicians (SEMG), the Spanish Association of Specialists in Occupational Medicine (AEEMT), the Spanish Association of Cardiovascular Nursing (AEEC), the Spanish Heart Foundation (FEC), and the Spanish Cancer Association (AECC).
Collapse
Affiliation(s)
- Ana Martín García
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, USAL, Salamanca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain.
| | - Cristina Mitroi
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pilar Mazón Ramos
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Ramón García Sanz
- Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), IBSAL, Salamanca, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC-ISCIII), Spain
| | | | - Meritxell Arenas
- Servicio de Oncología Radioterápica, Hospital Universitario San Juan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | | | - Dimpna Albert
- Servicio de Cardiología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | - Almudena Castro
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Raúl Córdoba
- Servicio de Hematología, Fundación Jiménez Díaz, Madrid, Spain
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Regina Dalmau
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Lucía Deiros Bronte
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Carlos Escobar Cervantes
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | | | - Teresa Lozano
- Servicio de Cardiología, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Pascual Marco Vera
- Servicio de Hematología y Hemoterapia, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - Amparo Martínez Monzonis
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Dolores Mesa
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Gerard Oristrell
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Milagros Pedreira
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | | | - Isabel Rodríguez
- Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Belén Toral
- Servicio de Cardiología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Torres Royo
- Servicio de Oncología Radioterápica, Hospital Universitario San Juan de Reus, Universidad Rovira i Virgili, Reus, Tarragona, Spain
| | | | | | - Eduardo Zatarain-Nicolás
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Juan Tamargo
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| | - Teresa López Fernández
- Servicio de Cardiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV-ISCIII), Spain
| |
Collapse
|
10
|
Brown JA, Aranda-Michel E, Kilic A, Serna-Gallegos D, Bianco V, Thoma FW, Sultan I. Impact of Thoracic Radiation on Patients Undergoing Cardiac Surgery. Semin Thorac Cardiovasc Surg 2021; 34:136-143. [PMID: 33609669 DOI: 10.1053/j.semtcvs.2021.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 01/01/2023]
Abstract
Prior thoracic radiation has been associated with worse outcomes after cardiac surgery. This study sought to report long-term outcomes in patients undergoing surgery for radiation-associated heart disease. This was an observational study of open cardiac surgeries from 2011 and 2018. Patients with a history of malignancy that required thoracic radiation were identified, and this cohort was matched against a non-irradiated comparison group via Mahalanobis distance matching. Kaplan-Meier survival estimation and multivariable Cox regression analysis was performed to assess the long-term impact of thoracic radiation in patients undergoing cardiac surgery. Of the 15,284 patients receiving cardiac surgery in this time-frame, 269 were identified with a history of thoracic radiation for prior malignancy. Patients with prior radiation had increased 1-year and 5-year mortality (P < 0.001), despite no difference for 30-day mortality (P = 0.719), compared to non-irradiated patients. Mahalanobis distance matching yielded 269 equitably matched pairs. On multivariable analysis, patients with prior radiation demonstrated significantly increased hazard of death, as compared to the non-irradiated group (hazard ratio 1.40, 95% confidence interval: 1.02, 1.94, P = 0.038). Patients with radiation for breast cancer demonstrated a non-significant trend toward reduced hazard of death, as compared to patients with more extensive radiation exposure. There was an increase in long-term mortality in patients with prior radiation undergoing cardiac surgery, however open cardiac surgery can safely be performed in these patients with similar operative mortality. These findings may serve as a useful adjunct in shared decision-making for patients and surgeons alike.
Collapse
Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W Thoma
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
11
|
Apte N, Dherange P, Mustafa U, Ya'qoub L, Dawson D, Higginbotham K, Boerma M, Morin DP, Gupta D, McLarty J, Mansour R, Dominic P. Cancer Radiation Therapy May Be Associated With Atrial Fibrillation. Front Cardiovasc Med 2021; 8:610915. [PMID: 33553271 PMCID: PMC7862558 DOI: 10.3389/fcvm.2021.610915] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023] Open
Abstract
Background: The association of atrial fibrillation (AF) with cancer and cancer types is inconclusive. Similarly, data regarding the association of AF with different cancer therapies are controversial. Objectives: To study the association of AF with cancer subtypes and cancer therapies. Methods: We studied all patients aged 18–89 years who presented to the Feist Weiller Cancer Center, with or without a diagnosis of cancer, between January 2011 and February 2016. Electronic health records were systematically queried for baseline demographics and ICD-9 and ICD-10 codes for specific co-morbidities. Patients with a diagnosis of AF were tabulated based on cross-validation with the ECG database and/or by recorded history. We assessed the prevalence and risk of AF based on cancer diagnosis, specific cancer type, and cancer therapy. Results: A total of 14,600 patients were analyzed. Compared to non-cancer patients (n = 6,801), cancer patients (n = 7,799) had a significantly higher prevalence of AF (4.3 vs. 3.1%; p < 0.001). However, following correction for covariates in a multivariable logistic regression model, malignancy was not found to be an independent risk factor for AF (p = 0.32). While patients with solid tumors had a numerically higher prevalence of AF than those with hematological malignancies (4.3 vs. 4.1%), tumor type was not independently associated with AF (p = 0.13). AF prevalence was higher in patients receiving chemotherapy (4.1%), radiation therapy (5.1%), or both (6.9%) when compared to patients not receiving any therapy (3.6%, p = 0.01). On multivariable logistic regression, radiation therapy remained an independent risk factor for AF for the entire study population (p = 0.03) as well as for the cancer population (p < 0.01). Conclusions: Radiation therapy for cancer is an independent risk factor for AF. The known association between cancer and AF may be mediated, at least in part, by the effects of radiation therapy.
Collapse
Affiliation(s)
- Nachiket Apte
- Department of Medicine and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
| | - Parinita Dherange
- Department of Medicine and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
| | - Usman Mustafa
- Department of Medicine and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
| | - Lina Ya'qoub
- Department of Medicine and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
| | - Desiree Dawson
- Department of Medicine and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
| | | | - Marjan Boerma
- Department of Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Daniel P Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States.,Department of Cardiology, University of Queensland Ochsner Clinical School, New Orleans, LA, United States
| | - Dipti Gupta
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jerry McLarty
- Department of Medicine and Feist Weiller Cancer Center, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
| | - Richard Mansour
- Department of Medicine and Feist Weiller Cancer Center, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
| | - Paari Dominic
- Department of Medicine and Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, United States
| |
Collapse
|
12
|
Extreme vascular calcification 40 years after radiotherapy in childhood. Coron Artery Dis 2021; 32:738-739. [PMID: 33471475 DOI: 10.1097/mca.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
In Situ Pulmonary Artery Thrombosis: Unrecognized Complication of Radiation Therapy. AJR Am J Roentgenol 2020; 215:1329-1334. [DOI: 10.2214/ajr.19.22741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
14
|
Sase K, Kida K, Furukawa Y. Cardio-Oncology rehabilitation- challenges and opportunities to improve cardiovascular outcomes in cancer patients and survivors. J Cardiol 2020; 76:559-567. [DOI: 10.1016/j.jjcc.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022]
|
15
|
Rassaf T, Totzeck M, Backs J, Bokemeyer C, Hallek M, Hilfiker-Kleiner D, Hochhaus A, Lüftner D, Müller OJ, Neudorf U, Pfister R, von Haehling S, Lehmann LH, Bauersachs J. Onco-Cardiology: Consensus Paper of the German Cardiac Society, the German Society for Pediatric Cardiology and Congenital Heart Defects and the German Society for Hematology and Medical Oncology. Clin Res Cardiol 2020; 109:1197-1222. [PMID: 32405737 PMCID: PMC7515958 DOI: 10.1007/s00392-020-01636-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022]
Abstract
The acute and long-lasting side effects of modern multimodal tumour therapy significantly impair quality of life and survival of patients afflicted with malignancies. The key components of this therapy include radiotherapy, conventional chemotherapy, immunotherapy and targeted therapies. In addition to established tumour therapy strategies, up to 30 new therapies are approved each year with only incompletely characterised side effects. This consensus paper discusses the risk factors that contribute to the development of a potentially adverse reaction to tumour therapy and, in addition, defines specific side effect profiles for different treatment groups. The focus is on novel therapeutics and recommendations for the surveillance and treatment of specific patient groups.
Collapse
Affiliation(s)
- Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Johannes Backs
- Institute for Experimental Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with the Section Pneumology, Centre for Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology ABCD, University Hospital of Cologne, Cologne, Germany
| | | | - Andreas Hochhaus
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - Diana Lüftner
- Department of Haematology, Oncology and Tumour Immunology, Charité, Humboldt University Berlin, Berlin, Germany
| | - Oliver J Müller
- Department of Internal Medicine III (Cardiology, Angiology and Internal Intensive Care Medicine), University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Ulrich Neudorf
- Department of Pediatrics III, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany
| | - Roman Pfister
- Clinic III for Internal Medicine, General and Interventional Cardiology, Electrophysiology, Angiology, Pneumology and Internal Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Lorenz H Lehmann
- Department of Cardiology, Angiology, Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
16
|
Zhou D, Yang WK, Zhang YF, Xie JH, Ma L, Yang HD, Li Y, Xie P. Sodium tanshinone IIA sulfonate prevents radiation-induced damage in primary rat cardiac fibroblasts. Chin J Nat Med 2020; 18:436-445. [PMID: 32503735 DOI: 10.1016/s1875-5364(20)30051-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Indexed: 12/19/2022]
Abstract
This study investigated the effects of X-ray irradiation on primary rat cardiac fibroblasts (CFs) and its potential mechanism, as well as whether sodium tanshinone IIA sulfonate (STS) has protective effect on CFs and its possible mechanism. Our data demonstrated that X-rays inhibited cell growth and increased oxidative stress in CFs, and STS mitigated X-ray-induced injury. Enzyme-linked immuno-sorbent assay showed that X-rays increased the levels of secreted angiotensin II (Ang II) and brain natriuretic peptide (BNP). STS inhibited the X-ray-induced increases in Ang II and BNP release. Apoptosis and cell cycle of CFs were analyzed using flow cytometry. X-rays induced apoptosis in CFs, whereas STS inhibited apoptosis in CFs after X-ray irradiation. X-rays induced S-phase cell cycle arrest in CFs, which could be reversed by STS. X-rays increased the expression of phosphorylated-P38/P38, cleaved caspase-3 and caspase-3 as well as decreased the expression of phosphorylated extracellular signal-regulated kinase 1/2 (ERK 1/2)/ERK 1/2 and B cell lymphoma 2 (Bcl-2)/Bcl-2 associated X protein (BAX) in CFs, as shown by Western blotting. STS mitigated the X-ray radiation-induced expression changes of these proteins. In conclusion, our results demonstrated that STS may potentially be developed as a medical countermeasure to mitigate radiation-induced cardiac damage.
Collapse
Affiliation(s)
- Dan Zhou
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China; School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Wen-Ke Yang
- School of Basic Medical Science, Lanzhou University, Lanzhou 730000, China
| | - Yi-Fan Zhang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China; Ningxia Medical University, Yinchuan 750004, China
| | - Jin-Hui Xie
- Gansu Provincial Hospital, Lanzhou 730000, China
| | - Li Ma
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China; Ningxia Medical University, Yinchuan 750004, China
| | | | - Yi Li
- School of Stomatology, Lanzhou University, Lanzhou 730000, China.
| | - Ping Xie
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China.
| |
Collapse
|
17
|
Graffagnino J, Kondapalli L, Arora G, Hawi R, Lenneman CG. Strategies to Prevent Cardiotoxicity. Curr Treat Options Oncol 2020; 21:32. [PMID: 32270293 DOI: 10.1007/s11864-020-0722-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT Cardiovascular disease is a leading cause of death among cancer survivors. While the field of cardiology as a whole is driven by evidence generated through robust clinical trials, data in cardio-oncology is limited to a relatively small number of prospective clinical trials with heterogeneous groups of cancer patients. In addition, many pharmaceutical trials in oncology are flawed from a cardiovascular perspective because they exclude patients with significant cardiovascular (CV) history and have wide variation in the definitions of CV events and cardiotoxicity. Ultimately, oncology trials often underrepresent the possibility of cardiovascular events in a "real world" population. Thus, the signal for CV toxicity from a cancer treatment is often not manifested until phase IV studies; where we are often caught trying to mitigate the CV effects rather than preventing them. Most of the data about cardiotoxicity from cancer therapy and cardioprotective strategies has been developed from our experience in using anthracyclines for over 50 years with dramatic improvement in cancer survivorship. However, as we are in an era where cancer drug discovery is moving at lightning pace with increasing survival rates, it is imperative to move beyond anthracyclines and commit to research on the cardiovascular side effects of all aspects of cancer therapy with a focus on prevention. We emphasize the role of pre-cancer treatment CV assessment to anticipate cardiac issues and ultimately optimizing CV risk prior to cancer therapy as an opportunity to mitigate cardiovascular risk from cancer therapy.
Collapse
Affiliation(s)
- Jason Graffagnino
- Department of Medicine, University of Alabama at Birmingham, 321 Lyons Harrison Research Building, 1720 2nd Ave South, Birmingham, AL, 35294, USA
| | - Lavanya Kondapalli
- Division of Cardiology, Department of Medicine, University of Colorado, 12631 E. 17th Ave, Mail Stop B130, Aurora, CO, 80045, USA
| | - Garima Arora
- Department of Medicine, University of Alabama at Birmingham, 321 Lyons Harrison Research Building, 1720 2nd Ave South, Birmingham, AL, 35294, USA
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Riem Hawi
- Department of Medicine, University of Alabama at Birmingham, 321 Lyons Harrison Research Building, 1720 2nd Ave South, Birmingham, AL, 35294, USA
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carrie G Lenneman
- Department of Medicine, University of Alabama at Birmingham, 321 Lyons Harrison Research Building, 1720 2nd Ave South, Birmingham, AL, 35294, USA.
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
18
|
Dilalla V, Chaput G, Williams T, Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Curr Oncol 2020; 27:107-112. [PMID: 32489253 PMCID: PMC7253739 DOI: 10.3747/co.27.6233] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Canadian Cancer Society estimated that 220,400 new cases of cancer would be diagnosed in 2019. Of the affected patients, more than 60% will survive for 5 years or longer after their cancer diagnosis. Furthermore, nearly 40% will receive at least 1 course of radiotherapy (rt). Radiotherapy is used with both curative and palliative intent: to treat early-stage or locally advanced tumours (curative) and for symptom management in advanced disease (palliative). It can be delivered systemically (external-beam rt) or internally (brachytherapy). Although technique improvements have drastically reduced the occurrence of rt-related toxicity, most patients still experience burdensome rt side effects (seffs). Radiotherapy seffs are local or locoregional, and manifest in tissues or organs that were irradiated. Side effects manifesting within weeks after rt completion are termed "early seffs," and those occurring months or years after treatment are termed "late seffs." In addition to radiation oncologists, general practitioners in oncology and primary care providers are involved in survivorship care and management of rt seffs. Here, we present an overview of common seffs and their respective management: anxiety, depression, fatigue, and effects related to the head-and-neck, thoracic, and pelvic treatment sites.
Collapse
Affiliation(s)
- V Dilalla
- Division of Radiation Oncology, McGill University, Montreal, QC
| | - G Chaput
- Department of Family Medicine (Secondary Care), Division of Supportive and Palliative Medicine, McGill University Health Centre, and McGill University, Montreal, QC
| | - T Williams
- Cancer Care Mission Patients' Committee, McGill University Health Centre, Montreal, QC
| | - K Sultanem
- Department of Oncology, Division of Radiation Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| |
Collapse
|
19
|
Shinano H, Miyazaki S, Miura K, Ohtsu H, Yonemoto N, Matsuoka K, Konishi H, Daida H, Saito M, Sase K. Risk Profiling of Cancer Treatment-Related Cardiovascular Disorders in Breast Cancer Patients Who Received Adjuvant Chemotherapy With Trastuzumab. Circ Rep 2020; 2:235-242. [PMID: 33693235 PMCID: PMC7921354 DOI: 10.1253/circrep.cr-19-0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/31/2020] [Accepted: 02/18/2020] [Indexed: 01/03/2023] Open
Abstract
Background: The prognosis of cancer survivors has dramatically improved, but effective strategies for cancer treatment-related cardiovascular disorders (CTRCD) remain to be elucidated in the emerging field of cardio-oncology. In this study, we investigated risk factors for CTRCD in breast cancer patients treated with trastuzumab. Methods and Results: We performed a retrospective analysis of 141 consecutive women who received adjuvant trastuzumab, and underwent baseline (BL) and follow-up (FU) echocardiography at Juntendo University between April 2010 and December 2016. The major concomitant treatment was anthracyclines in 94% and radiotherapy in 53%. During the median treatment period of 11 months, there were 22 (15.6%) cardiology consultations, 3 (2.1%) treatment interruptions with irreversible CTRCD, and no deaths. Left ventricular ejection fraction (LVEF) was decreased from a median 67.5% (BL) to 63.4% (FU; P<0.0001), with reduced LVEF noted in 26.2% at FU<90%BL, in 13.5% at FU
Collapse
Affiliation(s)
- Hiromi Shinano
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Kayo Miura
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Hiroshi Ohtsu
- Leading Center for the Development and Research of Cancer Medicine, Juntendo University Tokyo Japan
- Center for Clinical Sciences, Department of Data Science, National Center for Global Health and Medicine Tokyo Japan
- Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University Tokyo Japan
| | - Naohiro Yonemoto
- Innovative Medical Technology Research & Development Center, Juntendo University Tokyo Japan
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry Tokyo Japan
| | - Kiyoshi Matsuoka
- Innovative Medical Technology Research & Development Center, Juntendo University Tokyo Japan
- Center for Clinical Sciences, Department of Data Science, National Center for Global Health and Medicine Tokyo Japan
| | - Hakuou Konishi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University Tokyo Japan
- Innovative Medical Technology Research & Development Center, Juntendo University Tokyo Japan
| | - Mitsue Saito
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Juntendo University Tokyo Japan
| | - Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University Tokyo Japan
- Institute for Medical Regulatory Science, Organization for University Research Initiatives, Waseda University Tokyo Japan
| |
Collapse
|
20
|
Mrotzek SM, Rassaf T, Totzeck M. Cardiovascular Damage Associated With Chest Irradiation. Front Cardiovasc Med 2020; 7:41. [PMID: 32266294 PMCID: PMC7103638 DOI: 10.3389/fcvm.2020.00041] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/03/2020] [Indexed: 12/24/2022] Open
Abstract
The improvement of anticancer-therapies results in a greater amount of long-term survivors after radiotherapy. Therefore, the understanding of cardiotoxicity after irradiation is of increasing importance. Cardiovascular adverse events after chest irradiation have been acknowledged for a long time but remain difficult to diagnose. Long-term cardiovascular adverse events may become evident years or decades after radiotherapy and the spectrum of potential cardiovascular side effects is large. Recent experimental and clinical data indicate that cardiovascular symptoms may be caused especially by heart failure with preserved ejection fraction, which remains incompletely understood in patients after radiation therapy. Heart radiation dose and co-existing cardiovascular risk factors represent some of the most important contributors for incidence and severity of radiation-induced cardiovascular side effects. In this review, we aim to elucidate the underlying patho-mechanisms and to characterize the development of radiation-induced cardiovascular damage. Additionally, approaches for clinical management and treatment options are presented.
Collapse
Affiliation(s)
- Simone M Mrotzek
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| |
Collapse
|
21
|
Magnetic Resonance Imaging for the Follow-up of Treated Thymic Epithelial Malignancies. J Thorac Imaging 2020; 34:345-350. [PMID: 31464819 DOI: 10.1097/rti.0000000000000444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this article was to compare magnetic resonance imaging (MRI) depiction of thymic malignancy progression/recurrence with that of computed tomography (CT). METHODS We retrospectively reviewed all surgically treated thymic epithelial malignancy (TEM) patients between 2011 and 2018 who were followed-up with chest CT and MRI. We compared the detection of recurrence and metastatic disease between the CT and MRI scans in each of these patients. RESULTS Of 187 patients treated in our institution for TEM, 22 were followed-up with both CT and MRI. TNM stage at diagnosis was as follows: I (n=14), II (n=1), IIIa (n=4), IIIb (n=2), IVa (n=1), and IVb (n=0). Patients were followed-up for a mean of 6.2 years, range 0.7 to 17.7 years. The mean interval between CT and MRI was 5.4 (range, 1 to 15) months. Most patients had no recurrence (n=16), 4 had recurrence after R0 or R1 resection, 1 had stable disease, and 1 had progression of disease after R2 resection. CT and MRI performed equally in the identification of pleural spread (n=5), lymphadenopathy (n=4), and pulmonary metastases (n=1). Retrosternal recurrence (n=1) was identified by MRI despite sternotomy wire artifacts. MRI identified bone involvement and extension of disease into the thecal sac earlier and more readily. Three patients had an indeterminate mediastinal finding on CT that was correctly identified as a benign cyst or pericardial fluid collection by MRI. CONCLUSION MRI is an alternative option to follow-up patients after treatment for TEM. However, for those with metallic sternotomy wires, we recommend alternating the follow-up with CT as well.
Collapse
|
22
|
Lee MS, Liu DW, Hung SK, Yu CC, Chi CL, Chiou WY, Chen LC, Lin RI, Huang LW, Chew CH, Hsu FC, Chan MWY, Lin HY. Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care. Front Cardiovasc Med 2020; 7:16. [PMID: 32154267 PMCID: PMC7047711 DOI: 10.3389/fcvm.2020.00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/31/2020] [Indexed: 02/06/2023] Open
Abstract
Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.
Collapse
Affiliation(s)
- Moon-Sing Lee
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Dai-Wei Liu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Chih-Chia Yu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
| | - Chen-Lin Chi
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Anatomic Pathology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Liang-Cheng Chen
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Ru-Inn Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
| | - Li-Wen Huang
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Chia-Hui Chew
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Feng-Chun Hsu
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
| | - Michael W Y Chan
- Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
| | - Hon-Yi Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,Cancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.,Department of Biomedical Sciences, National Chung Cheng University, Chia-Yi, Taiwan
| |
Collapse
|
23
|
|