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Cao C, Wu R, Wang S, Zhuang L, Chen P, Li S, Zhu Q, Li H, Lin Y, Li M, Cao L, Chen J. Elucidating the changes in the heterogeneity and function of radiation-induced cardiac macrophages using single-cell RNA sequencing. Front Immunol 2024; 15:1363278. [PMID: 38601160 PMCID: PMC11004337 DOI: 10.3389/fimmu.2024.1363278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/08/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose A mouse model of irradiation (IR)-induced heart injury was established to investigate the early changes in cardiac function after radiation and the role of cardiac macrophages in this process. Methods Cardiac function was evaluated by heart-to-tibia ratio, lung-to-heart ratio and echocardiography. Immunofluorescence staining and flow cytometry analysis were used to evaluate the changes of macrophages in the heart. Immune cells from heart tissues were sorted by magnetic beads for single-cell RNA sequencing, and the subsets of macrophages were identified and analyzed. Trajectory analysis was used to explore the differentiation relationship of each macrophage subset. The differentially expressed genes (DEGs) were compared, and the related enriched pathways were identified. Single-cell regulatory network inference and clustering (SCENIC) analysis was performed to identify the potential transcription factors (TFs) which participated in this process. Results Cardiac function temporarily decreased on Day 7 and returned to normal level on Day 35, accompanied by macrophages decreased and increased respectively. Then, we identified 7 clusters of macrophages by single-cell RNA sequencing and found two kinds of stage specific macrophages: senescence-associated macrophage (Cdkn1ahighC5ar1high) on Day 7 and interferon-associated macrophage (Ccr2highIsg15high) on Day 35. Moreover, we observed cardiac macrophages polarized over these two-time points based on M1/M2 and CCR2/major histocompatibility complex II (MHCII) expression. Finally, Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analyses suggested that macrophages on Day 7 were characterized by an inflammatory senescent phenotype with enhanced chemotaxis and inflammatory factors, while macrophages on Day 35 showed enhanced phagocytosis with reduced inflammation, which was associated with interferon-related pathways. SCENIC analysis showed AP-1 family members were associated with IR-induced macrophages changes. Conclusion We are the first study to characterize the diversity, features, and evolution of macrophages during the early stages in an IR-induced cardiac injury animal model.
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Affiliation(s)
- Chunxiang Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Ran Wu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Shubei Wang
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Lingfang Zhuang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peizhan Chen
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuyan Li
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Qian Zhu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Huan Li
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Yingying Lin
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Min Li
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Proton-therapy, Shanghai, China
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Wittmann A, Bartels A, Alkotub B, Bauer L, Kafshgari MH, Multhoff G. Chronic inflammatory effects of in vivo irradiation of the murine heart on endothelial cells mimic mechanisms involved in atherosclerosis. Strahlenther Onkol 2023; 199:1214-1224. [PMID: 37658922 PMCID: PMC10673733 DOI: 10.1007/s00066-023-02130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/16/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Radiotherapy is a major pillar in the treatment of solid tumors including breast cancer. However, epidemiological studies have revealed an increase in cardiac diseases approximately a decade after exposure of the thorax to ionizing irradiation, which might be related to vascular inflammation. Therefore, chronic inflammatory effects were examined in primary heart and lung endothelial cells (ECs) of mice after local heart irradiation. METHODS Long-lasting effects on primary ECs of the heart and lung were studied 20-50 weeks after local irradiation of the heart of mice (8 and 16 Gy) in vivo by multiparameter flow cytometry using antibodies directed against cell surface markers related to proliferation, stemness, lipid metabolism, and inflammation, and compared to those induced by occlusion of the left anterior descending coronary artery. RESULTS In vivo irradiation of the complete heart caused long-lasting persistent upregulation of inflammatory (HCAM, ICAM‑1, VCAM-1), proliferation (CD105), and lipid (CD36) markers on primary heart ECs and an upregulation of ICAM‑1 and VCAM‑1 on primary ECs of the partially irradiated lung lobe. An artificially induced heart infarction induces similar effects with respect to inflammatory markers, albeit in a shorter time period. CONCLUSION The long-lasting upregulation of prominent inflammatory markers on primary heart and lung ECs suggests that local heart irradiation induces chronic inflammation in the microvasculature of the heart and partially irradiated lung that leads to cardiac injury which might be related to altered lipid metabolism in the heart.
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Affiliation(s)
- Andrea Wittmann
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Anna Bartels
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Bayan Alkotub
- Institute of Biological Medical Imaging, Helmholtz-Zentrum München (HMGU), Neuherberg, Munich, Germany
| | - Lisa Bauer
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Morteza Hasanzadeh Kafshgari
- Center for Translational Cancer Research (TranslaTUM), Heinz-Nixdorf-Chair for Biomedical Electronics, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Gabriele Multhoff
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.
- Center for Translational Cancer Research (TranslaTUM), School of Medicine Radiation Immuno-Oncology Group, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaningerstr. 22, 81675, Munich, Germany.
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von Kemp BA, Cosyns B. Radiation-Induced Pericardial Disease: Mechanisms, Diagnosis, and Treatment. Curr Cardiol Rep 2023; 25:1113-1121. [PMID: 37584875 DOI: 10.1007/s11886-023-01933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW We aim to give a concise overview of the different clinical manifestations of both acute and long-term radiotherapy-related pericardial diseases, the underlying pathophysiology as well as the diagnosis and treatment options. RECENT FINDINGS Radiotherapy-related pericardial disease is common, but despite radiotherapy being a cornerstone of many cancer treatments, this disease entity is relatively underrepresented in clinical trials, resulting in a paucity of research data on pathophysiology and management. Since the development of innovative cancer treatments, survival has significantly improved. Therefore, the importance of long-term treatment-related side effects increases, most notably cancer treatment-related cardiovascular toxicity. In patients undergoing radiotherapy as a part of their cancer treatment, radiotherapy-related pericardial disease can manifest early (during or shortly after radiotherapy administration) or very late (several years to decades after treatment). This exceptionally long latency period confronts physicians with treatment-related side effects of radiotherapy regimens that may have been abandoned already.
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Affiliation(s)
- Berlinde A von Kemp
- Dienst Cardiologie, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Bernard Cosyns
- Dienst Cardiologie, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Walls GM, O'Connor J, Harbinson M, McCarron EP, Duane F, McCann C, McKavanagh P, Johnston DI, Erekkath J, Giacometti V, Gavin AT, McAleese J, Hounsell AR, Cole AJ, Butterworth KT, McGarry CK, Hanna GG, Jain S. Association between statin therapy dose intensity and radiation cardiotoxicity in non-small cell lung cancer: Results from the NI-HEART study. Radiother Oncol 2023; 186:109762. [PMID: 37348608 DOI: 10.1016/j.radonc.2023.109762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Radiation cardiotoxicity is a dose-limiting toxicity and major survivorship issue for patients with non-small cell lung cancer (NSCLC) completing curative-intent radiotherapy, however patients' cardiovascular baseline is not routinely optimised prior to treatment. In this study we examined the impact of statin therapy on overall survival and post-radiotherapy cardiac events. METHODS Patients treated between 2015-2020 at a regional center were identified. Clinical notes were interrogated for baseline patient, tumor and cardiac details, and both follow-up cancer control and cardiac events. Three cardiologists verified cardiac events. Radiotherapy planning scans were retrieved for application of validated deep learning-based autosegmentation. Pre-specified Cox regression analyses were generated with varying degrees of adjustment for overall survival. Fine and Gray regression for the risk of cardiac events, accounting for the competing risk of death and cardiac covariables was undertaken. RESULTS Statin therapy was prescribed to 59% of the 478 included patients. The majority (88%) of patients not prescribed a statin had at least one indication for statin therapy according to cardiovascular guidelines. In total, 340 patients (71%) died and 79 patients (17%) experienced a cardiac event. High-intensity (HR 0.68, 95%CI 0.50-0.91, p = 0.012) and medium-intensity (HR 0.70, 95%CI 0.51-0.97, p = 0.033) statin therapy were associated with improved overall survival after adjustment for patient, cancer, treatment, response and cardiovascular clinical factors. There were no consistent differences in the rate or grade of cardiac events according to statin intensity. CONCLUSIONS Statin therapy is associated with improved overall survival in patients receiving curative-intent radiotherapy for NSCLC, and there is evidence of a dose-response relationship. This study highlights the importance of a pre-treatment cardiovascular risk assessment in this cohort. Further studies are needed to examine if statin therapy is cardioprotective in patients undergoing treatment for NSCLC with considerable incidental cardiac radiation dose and a low baseline cardiac risk.
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Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom.
| | - John O'Connor
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Mark Harbinson
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Eamon P McCarron
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom; Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast Health and Social Care Trust, Falls Road, Belfast, Northern Ireland, United Kingdom
| | - Frances Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
| | - Conor McCann
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Peter McKavanagh
- Department of Cardiology, Ulster Hospital, South Eastern Health & Social Care Trust, Upper Newtonards Road, Dundonald, Northern Ireland, United Kingdom
| | - David I Johnston
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Jayaraj Erekkath
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Valentina Giacometti
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Falls Road, Belfast, Northern Ireland, United Kingdom
| | - Jonathan McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Alan R Hounsell
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Aidan J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Karl T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Conor K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Gerard G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Suneil Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
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Shen S, Lyu P, Yang B, Yang X, Li Y, Zhu Z, Shen L. Identification of circRNAs and circRNA-miRNA-mRNA regulatory network in radiation-induced heart disease. Int J Radiat Biol 2023; 99:1343-1351. [PMID: 36731456 DOI: 10.1080/09553002.2023.2176560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Radiation-induced heart disease (RIHD) is one of the most common and serious long-term adverse effect after thoracic radiotherapy. Our aim was to investigate the potential molecular mechanism underlying RIHD using RNA-sequencing (RNA-seq) and bioinformatics methods. MATERIALS AND METHODS An RIHD rat model was established and transcription profiles were identified using RNA-seq. Differentially expressed circRNAs, miRNAs and mRNAs were identified. Enrichment of functions and signaling pathways analysis were performed based on GO and the KEGG database. Potential circRNA-miRNA-mRNA regulatory network underlying RIHD was established. qRT-PCR was used to validate the associated genes. RESULTS In total, 21 circRNAs, 26 miRNAs, and 178 mRNA transcripts were differentially expressed in RIHD. GO and KEGG pathway analyses identified that differentially expressed mRNAs were most enriched in pathways referring to endothelial function and vascular pathological processes. Nine circRNAs, 10 miRNAs, and 6 mRNA transcripts were most likely involved in vascular function and a candidate competitive endogenous RNA (ceRNA) network of circRNA-miRNA-mRNA was established, which were further validated by qRT-PCR. CONCLUSIONS Our study revealed that vascular pathology plays an important role in the early stage of RIHD. Furthermore, a circRNA-miRNA-mRNA ceRNA network was found that may be involved in the regulation of vascular function and RIHD.
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Affiliation(s)
- Shutong Shen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Ping Lyu
- Department of Cardiology, The First People's Hospital of Nantong, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Baixia Yang
- Department of Radiation Oncology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Xi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yida Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Li Shen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
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Wang R, Ye H, Zhao Y, Ma L, Wei J, Wang Y, Zhang X, Wang L. Effect of radiotherapy on cardiac-specific death in patients with non-malignant tumors of central nervous system and related clinical features. Front Cardiovasc Med 2022; 9:991621. [PMID: 36277796 PMCID: PMC9582928 DOI: 10.3389/fcvm.2022.991621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Importance Cardiac-specific death from radiation caused by radiation therapy (RT) in patients with malignant tumors has received extensive attention, however, little is known regarding the potential cardiotoxic effects of RT in patients with non-malignant tumors. Objectives and methods In this study, we used the SEER data to explore the incidence of post-radiation cardiovascular complications in patients with non-malignant tumors of central nervous system (CNS), and identify the influencing factors of cardiac-specific death. Results Ultimately 233, 306 patients were included (97.8% of patients had brain tumors and 2.2% had spinal cord tumors). For patients with non-malignant tumors of CNS, RT {yes (odds ratio [OR] 0.851, 95% confidence interval [CI] 0.774–0.936, p = 0.001, before propensity score matching (PSM); OR 0.792, 95% CI 0.702–0.894, p < 0.001, after PSM) vs. no} was associated with lower risk of cardiac-specific death, other clinical features affecting cardiac death similar to those in patients with non-malignant tumors of CNS receiving RT. For patients with non-malignant tumors of CNS receiving RT, female, married status, Hispanic ethnicity, surgery, and tumor site (brain exclude nerve and endocrine, nervous system) were associated with lower risks of cardiac-specific death, while earlier year of diagnosis, older age of diagnosis, Black, larger tumor and bilateral tumor were risk factors for cardiac-specific death. Conclusions Our study shows the influencing factors for cardiac-specific death in patients with non-malignant tumors of CNS, and found RT is associated with lower risk of cardiac-specific death. These results can facilitate the identification of patients with non-malignant tumors of CNS who can benefit from RT while avoiding cardiovascular events. In addition, this study helps to enhance the clinical use of RT in these populations, especially in patients who may have impaired cardiac function due to CNS tumors.
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Affiliation(s)
- Ruxin Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Haowen Ye
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yongting Zhao
- Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li Ma
- Functional Examination Section, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Hospital), Lanzhou, China
| | - Jinjing Wei
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ying Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaofang Zhang
- Clinical Experimental Center, The First Affiliated Hospital of Jinan University, Guangzhou, China,Xiaofang Zhang
| | - Lihong Wang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China,*Correspondence: Lihong Wang
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Walls GM, O'Kane R, Ghita M, Kuburas R, McGarry CK, Cole AJ, Jain S, Butterworth KT. Murine models of radiation cardiotoxicity: A systematic review and recommendations for future studies. Radiother Oncol 2022; 173:19-31. [PMID: 35533784 DOI: 10.1016/j.radonc.2022.04.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The effects of radiation on the heart are dependent on dose, fractionation, overall treatment time, and pre-existing cardiovascular pathology. Murine models have played a central role in improving our understanding of the radiation response of the heart yet a wide range of exposure parameters have been used. We evaluated the study design of published murine cardiac irradiation experiments to assess gaps in the literature and to suggest guidance for the harmonisation of future study reporting. METHODS AND MATERIALS A systematic review of mouse/rat studies published 1981-2021 that examined the effect of radiation on the heart was performed. The protocol was published on PROSPERO (CRD42021238921) and the findings were reported in accordance with the PRISMA guidance. Risk of bias was assessed using the SYRCLE checklist. RESULTS 159 relevant full-text original articles were reviewed. The heart only was the target volume in 67% of the studies and simulation details were unavailable for 44% studies. Dosimetry methods were reported in 31% studies. The pulmonary effects of whole and partial heart irradiation were reported in 13% studies. Seventy-eight unique dose-fractionation schedules were evaluated. Large heterogeneity was observed in the endpoints measured, and the reporting standards were highly variable. CONCLUSIONS Current murine models of radiation cardiotoxicity cover a wide range of irradiation configurations and latency periods. There is a lack of evidence describing clinically relevant dose-fractionations, circulating biomarkers and radioprotectants. Recommendations for the consistent reporting of methods and results of in vivo cardiac irradiation studies are made to increase their suitability for informing the design of clinical studies.
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Affiliation(s)
- Gerard M Walls
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland; Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland.
| | - Reagan O'Kane
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Mihaela Ghita
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Refik Kuburas
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
| | - Conor K McGarry
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland; Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Aidan J Cole
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland; Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Suneil Jain
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland; Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland
| | - Karl T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Lisburn Road, Belfast, Northern Ireland
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Abravan A, Price G, Banfill K, Marchant T, Craddock M, Wood J, Aznar MC, McWilliam A, van Herk M, Faivre-Finn C. Role of Real-World Data in Assessing Cardiac Toxicity After Lung Cancer Radiotherapy. Front Oncol 2022; 12:934369. [PMID: 35928875 PMCID: PMC9344971 DOI: 10.3389/fonc.2022.934369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Radiation-induced heart disease (RIHD) is a recent concern in patients with lung cancer after being treated with radiotherapy. Most of information we have in the field of cardiac toxicity comes from studies utilizing real-world data (RWD) as randomized controlled trials (RCTs) are generally not practical in this field. This article is a narrative review of the literature using RWD to study RIHD in patients with lung cancer following radiotherapy, summarizing heart dosimetric factors associated with outcome, strength, and limitations of the RWD studies, and how RWD can be used to assess a change to cardiac dose constraints.
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Affiliation(s)
- Azadeh Abravan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Gareth Price
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Kathryn Banfill
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tom Marchant
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Matthew Craddock
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Joe Wood
- Christie Medical Physics and Engineering, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Marianne C. Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Alan McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Marcel van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
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Liu BY, Rehmani S, Kale MS, Marshall D, Rosenzweig KE, Kong CY, Wisnivesky J, Sigel K. Risk of Cardiovascular Toxicity According to Tumor Laterality Among Older Patients With Early Stage Non-small Cell Lung Cancer Treated With Radiation Therapy. Chest 2022; 161:1666-1674. [DOI: 10.1016/j.chest.2021.12.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022] Open
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The Influence of Radiotherapy on the Function of the Left and Right Ventricles in Relation to the Radiation Dose Administered to the Left Anterior Descending Coronary Artery—From a Cardiologist’s Point of View. Cancers (Basel) 2022; 14:cancers14102420. [PMID: 35626025 PMCID: PMC9139235 DOI: 10.3390/cancers14102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to assess the effects of radiotherapy involving the heart on LV and RV function using modern speckle-tracking echocardiography (STE), and in relation to the radiation dose applied to the LAD. This retrospective, single-centre study included 12 patients after a median of 51 months after irradiation for mediastinal lymphoma, in whom we were able to delineate the LAD. Correlations between doses of ionising radiation and echocardiographic parameters reflecting the systolic function of the LV and RV were analysed. The median irradiation dose delivered to the whole heart was 16.4 Gy (0.5–36.2 Gy), and to the LAD it was 15.1 Gy (0.3–35.3 Gy). LV longitudinal strain (LS) was impaired in the anteroseptal and anterior walls. Parameters reflecting RV function were normal, with the exception of RV myocardial performance index (RIMP). Significant correlations were found between the median dose to the LAD and LV global LS (rho = 0.6468, p = 0.034), the maximum dose to the LAD and LV anterior LS (rho = 0.6046, p = 0.049), the median and the mean dose to the whole heart and LV anterior LS (R = 0.772, p = 0.009 and rho = 0.7676, p = 0.01, respectively), and the total irradiation dose and RIMP (rho = 0.5981, p = 0.04). The calculation of irradiation doses allows the identification of patients at risk of cardiac dysfunction detected by modern STE.
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Ouyang W, Fu S, Zhao X, Su S, Zhang J, Luo D, Liu L, Ding W, Cao D, Liu L, He Z, Lu B. Recombinant human endostatin combined with radiotherapy promotes cardiomyocyte apoptosis in rats via TGFβ1/Smads/CTGF signaling pathway. BMC Cardiovasc Disord 2022; 22:97. [PMID: 35279096 PMCID: PMC8917752 DOI: 10.1186/s12872-022-02499-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 02/03/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose The aim of the present study was to investigate the efficacy of recombinant human endostatin (ES) (rh-ES) combined with radiation on rat cardiomyocyte apoptosis and the regulatory mechanism of transforming growth factor beta1 (TGF-β1)/Sma and Mad-related protein 3 (Smad3)/connective tissue growth factor (CTGF) signaling. Method The primary cardiomyocytes were isolated from neonatal Sprague–Dawley rats for culture in vitro and divided into blank control group (without treatment), 10 Gy radiation + siTGF-β1 siRNA (gene silencing) group, ES + siTGF-β1 siRNA group, and 10 Gy radiation + ES + siTGF-β1 siRNA group. Methyl thiazolyl tetrazolium assay was used to calculate the half-maximal inhibitory concentration (IC50) of rh-ES on cardiomyocytes. Adenoviral vector was constructed for virus packaging to silence TGF-β1 expression in cardiomyocytes. Quantitative real-time polymerase chain reaction and Western blot were carried out to analyze TGF-β1, Smad2, Smad3 and CTGF expression at both gene and protein levels. Flow cytometry and electron microscope were used to examine cell apoptosis. Results ES had a dose-dependent inhibitory effect on the proliferation of primary rat cardiomyocytes. ES combined with radiotherapy significantly inhibited cardiomyocyte proliferation and promoted cell apoptosis (P < 0.01). The gene and protein expression of TGF-β1, Smad2, Smad3 and CTGF were significantly up-regulated in primary cardiomyocytes transfected with TGF-β1 gene (P < 0.05). Conclusion The combination therapy with rh-ES and radiation can promote cardiomyocyte apoptosis and aggravate myocardial cell damage via TGF-β1/Smad3/CTGF signaling pathway. Supplementary information The online version contains supplementary material available at 10.1186/s12872-022-02499-8.
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Kovács MG, Kovács ZZA, Varga Z, Szűcs G, Freiwan M, Farkas K, Kővári B, Cserni G, Kriston A, Kovács F, Horváth P, Földesi I, Csont T, Kahán Z, Sárközy M. Investigation of the Antihypertrophic and Antifibrotic Effects of Losartan in a Rat Model of Radiation-Induced Heart Disease. Int J Mol Sci 2021; 22:12963. [PMID: 34884782 PMCID: PMC8657420 DOI: 10.3390/ijms222312963] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022] Open
Abstract
Radiation-induced heart disease (RIHD) is a potential late side-effect of thoracic radiotherapy resulting in left ventricular hypertrophy (LVH) and fibrosis due to a complex pathomechanism leading to heart failure. Angiotensin-II receptor blockers (ARBs), including losartan, are frequently used to control heart failure of various etiologies. Preclinical evidence is lacking on the anti-remodeling effects of ARBs in RIHD, while the results of clinical studies are controversial. We aimed at investigating the effects of losartan in a rat model of RIHD. Male Sprague-Dawley rats were studied in three groups: (1) control, (2) radiotherapy (RT) only, (3) RT treated with losartan (per os 10 mg/kg/day), and were followed for 1, 3, or 15 weeks. At 15 weeks post-irradiation, losartan alleviated the echocardiographic and histological signs of LVH and fibrosis and reduced the overexpression of chymase, connective tissue growth factor, and transforming growth factor-beta in the myocardium measured by qPCR; likewise, the level of the SMAD2/3 protein determined by Western blot decreased. In both RT groups, the pro-survival phospho-AKT/AKT and the phospho-ERK1,2/ERK1,2 ratios were increased at week 15. The antiremodeling effects of losartan seem to be associated with the repression of chymase and several elements of the TGF-β/SMAD signaling pathway in our RIHD model.
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Affiliation(s)
- Mónika Gabriella Kovács
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Zsuzsanna Z. A. Kovács
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Zoltán Varga
- Department of Oncotherapy, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (Z.V.); (Z.K.)
| | - Gergő Szűcs
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Marah Freiwan
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Katalin Farkas
- Department of Laboratory Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (K.F.); (I.F.)
| | - Bence Kővári
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (B.K.); (G.C.)
| | - Gábor Cserni
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (B.K.); (G.C.)
| | - András Kriston
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research Network, H-6726 Szeged, Hungary; (A.K.); (F.K.); (P.H.)
- Single-Cell Technologies Ltd., H-6726 Szeged, Hungary
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FIN-00014 Helsinki, Finland
| | - Ferenc Kovács
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research Network, H-6726 Szeged, Hungary; (A.K.); (F.K.); (P.H.)
- Single-Cell Technologies Ltd., H-6726 Szeged, Hungary
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FIN-00014 Helsinki, Finland
| | - Péter Horváth
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research Network, H-6726 Szeged, Hungary; (A.K.); (F.K.); (P.H.)
- Single-Cell Technologies Ltd., H-6726 Szeged, Hungary
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, FIN-00014 Helsinki, Finland
| | - Imre Földesi
- Department of Laboratory Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (K.F.); (I.F.)
| | - Tamás Csont
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
| | - Zsuzsanna Kahán
- Department of Oncotherapy, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (Z.V.); (Z.K.)
| | - Márta Sárközy
- Interdisciplinary Center of Excellence and MEDICS Research Group, Department of Biochemistry, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary; (M.G.K.); (Z.Z.A.K.); (G.S.); (M.F.)
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Chauhan V, Hamada N, Monceau V, Ebrahimian T, Adam N, Wilkins RC, Sebastian S, Patel ZS, Huff JL, Simonetto C, Iwasaki T, Kaiser JC, Salomaa S, Moertl S, Azimzadeh O. Expert consultation is vital for adverse outcome pathway development: a case example of cardiovascular effects of ionizing radiation. Int J Radiat Biol 2021; 97:1516-1525. [PMID: 34402738 DOI: 10.1080/09553002.2021.1969466] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The circulatory system distributes nutrients, signaling molecules, and immune cells to vital organs and soft tissues. Epidemiological, animal, and in vitro cellular mechanistic studies have highlighted that exposure to ionizing radiation (IR) can induce molecular changes in cellular and subcellular milieus leading to long-term health impacts, particularly on the circulatory system. Although the mechanisms for the pathologies are not fully elucidated, endothelial dysfunction is proven to be a critical event via radiation-induced oxidative stress mediators. To delineate connectivities of events specifically to cardiovascular disease (CVD) initiation and progression, the adverse outcome pathway (AOP) approach was used with consultation from field experts. AOPs are a means to organize information around a disease of interest to a regulatory question. An AOP begins with a molecular initiating event and ends in an adverse outcome via sequential linkages of key event relationships that are supported by evidence in the form of the modified Bradford-Hill criteria. Detailed guidelines on building AOPs are provided by the Organisation for Economic Cooperation and Development (OECD) AOP program. Here, we report on the questions and discussions needed to develop an AOP for CVD resulting from IR exposure. A recent workshop jointly organized by the MELODI (Multidisciplinary European Low Dose Initiative) and the ALLIANCE (European Radioecology Alliance) associations brought together experts from the OECD to present the AOP approach and tools with examples from the toxicology field. As part of this workshop, four working groups were formed to discuss the identification of adverse outcomes relevant to radiation exposures and development of potential AOPs, one of which was focused on IR-induced cardiovascular effects. Each working group comprised subject matter experts and radiation researchers interested in the specific disease area and included an AOP coach. CONCLUSION The CVD working group identified the critical questions of interest for AOP development, including the exposure scenario that would inform the evidence, the mechanisms of toxicity, the initiating event, intermediate key events/relationships, and the type of data currently available. This commentary describes the four-day discussion of the CVD working group, its outcomes, and demonstrates how collaboration and expert consultation is vital to informing AOP construction.
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Affiliation(s)
- Vinita Chauhan
- Consumer and Clinical Radiation Bureau, Health Canada, Ottawa, Canada
| | - Nobuyuki Hamada
- Radiation Safety Unit, Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Virginie Monceau
- Institute of Radiation and Nuclear Safety (IRSN), Radiotoxicology and Radiobiology Research Laboratory (LRTOX), Fontenay-Aux-Roses, France
| | - Teni Ebrahimian
- Institute of Radiation and Nuclear Safety (IRSN), Radiotoxicology and Radiobiology Research Laboratory (LRTOX), Fontenay-Aux-Roses, France
| | - Nadine Adam
- Consumer and Clinical Radiation Bureau, Health Canada, Ottawa, Canada
| | - Ruth C Wilkins
- Consumer and Clinical Radiation Bureau, Health Canada, Ottawa, Canada
| | - Soji Sebastian
- Radiobiology, Canadian Nuclear Laboratories, Chalk River, Canada
| | - Zarana S Patel
- KBR Inc, Houston, TX, USA.,NASA Johnson Space Center, Houston, TX, USA
| | | | - Cristoforo Simonetto
- Helmholtz Zentrum München, Institute of Radiation Medicine (HMGU-IRM), Neuherberg, Germany
| | - Toshiyasu Iwasaki
- Radiation Safety Unit, Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Jan Christian Kaiser
- Helmholtz Zentrum München, Institute of Radiation Medicine (HMGU-IRM), Neuherberg, Germany
| | - Sisko Salomaa
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Simone Moertl
- Section Radiation Biology, Federal Office for Radiation Protection (BfS), Neuherberg, Germany
| | - Omid Azimzadeh
- Section Radiation Biology, Federal Office for Radiation Protection (BfS), Neuherberg, Germany
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Pignol JP, Hoekstra N, Wilke D, Dahn H, Nolan M, Vicini F. Estimation of Annual Secondary Lung Cancer Deaths Using Various Adjuvant Breast Radiotherapy Techniques for Early-Stage Cancers. Front Oncol 2021; 11:713328. [PMID: 34434899 PMCID: PMC8381359 DOI: 10.3389/fonc.2021.713328] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Secondary lung cancer (SLC) can offset the benefit of adjuvant breast radiotherapy (RT), and risks compound sharply after 25 to 30 years. We hypothesized that SLC risk is mainly an issue for early-stage breast cancer, and that lives could be saved using different RT techniques. Patients and Methods The SEER database was used to extract breast patient age, stage survival, and radiotherapy utilization over time and per stage and to assess the factors associated with increased SLC risk with a multivariable competing risk Cox model. The number of SLC was calculated using the BEIR model modified with patient survival, age, and use of RT from the SEER database. Stage distribution and number of new breast cancer cases were obtained from the NAACCR. Mean lung dose for various irradiation techniques was obtained from measurement or literature. Results Out of the 765,697 non-metastatic breast cancers in the SEER database from 1988 to 2012, 49.8% received RT. RT significantly increased the SLC risk for longer follow-up (HR=1.58), early stage including DCIS, stage I and IIA (HR = 1.11), and younger age (HR=1.061) (all p<0.001). More advanced stages did not have significantly increased risk. In 2019, 104,743 early-stage breast patients received radiotherapy, and an estimated 3,413 will develop SLC (3.25%) leading to an excess of 2,900 deaths (2.77%). VMAT would reduce this mortality by 9.9%, hypofractionation 26 Gy in five fractions by 38.8%, a prone technique by 70.3%, 3D-CRT APBI by 43.3%, HDR brachytherapy by 71.1%, LDR by 80.7%, and robotic 4π APBI by 85.2%. Conclusions SLC after breast RT remains a clinically significant issue for early-stage breast cancers. This mortality could be significantly reduced using a prone technique or APBI.
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Affiliation(s)
- Jean-Philippe Pignol
- Radiation Oncology Department, Dalhousie University, Halifax, NS, Canada.,Radiation Oncology Department, Erasmus MC, Rotterdam, Netherlands
| | - Nienke Hoekstra
- Radiation Oncology Department, Erasmus MC, Rotterdam, Netherlands
| | - Derek Wilke
- Radiation Oncology Department, Dalhousie University, Halifax, NS, Canada
| | - Hannah Dahn
- Radiation Oncology Department, Dalhousie University, Halifax, NS, Canada
| | - Maureen Nolan
- Radiation Oncology Department, Dalhousie University, Halifax, NS, Canada
| | - Frank Vicini
- Radiation Oncology, 21st Century Oncology, Farmington Hills, MI, United States
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15
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Chmielewski-Stivers N, Petit B, Ollivier J, Monceau V, Tsoutsou P, Quintela Pousa A, Lin X, Limoli C, Vozenin MC. Sex-Specific Differences in Toxicity Following Systemic Paclitaxel Treatment and Localized Cardiac Radiotherapy. Cancers (Basel) 2021; 13:cancers13163973. [PMID: 34439129 PMCID: PMC8394799 DOI: 10.3390/cancers13163973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary The objective of the present study was to investigate the impact of sex in the development of long-term toxicities affecting quality of life in cancer survivors after systemic paclitaxel treatment and cardiac irradiation. Sex-specific differences may affect tumor biology, drug pharmacokinetics and dynamics, and response to local treatment such as radiation therapy (RT). However, sex is rarely taken into consideration when administering cancer therapies. Interestingly, female mice are protected from paclitaxel-induced neurotoxicity as well as from radiotherapy-induced cardiotoxicity, and deficiency in the small GTPase RhoB reversed the protection in females but not in males. In conclusion, our results are the first to identify sex- and organ-specific responses to systemic paclitaxel administration and localized RT. These results may have important implications for the management of cancer patients and implementation of personalized medicine in oncology. Abstract The impact of sex in the development of long-term toxicities affecting the quality of life of cancer survivors has not been investigated experimentally. To address this issue, a series of neurologic and cardiologic endpoints were used to investigate sex-based differences triggered by paclitaxel treatment and radiotherapy exposure. Male and female wild-type (WT) mice were treated with paclitaxel (150 and 300 mg/kg) administered weekly over 6 weeks or exposed to 19 Gy cardiac irradiation. Cohorts were analyzed for behavioral and neurobiologic endpoints to assess systemic toxicity of paclitaxel or cardiovascular endpoints to assess radiotherapy toxicity. Interestingly, female WT mice exhibited enhanced tolerance compared to male WT mice regardless of the treatment regimen. To provide insight into the possible sex-specific protective mechanisms, rhoB-deficient animals and elderly mice (22 months) were used with a focus on the possible contribution of sex hormones, including estrogen. In females, RhoB deficiency and advanced age had no impact on neurocognitive impairment induced by paclitaxel but enhanced cardiac sensitivity to radiotherapy. Conversely, rhoB-deficiency protected males from radiation toxicity. In sum, RhoB was identified as a molecular determinant driving estrogen-dependent cardioprotection in female mice, whereas neuroprotection was not sex hormone dependent. To our knowledge, this study revealed for the first time sex- and organ-specific responses to paclitaxel and radiotherapy.
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Affiliation(s)
- Nicole Chmielewski-Stivers
- Department of Radiation Oncology, University of California at Irvine, Irvine, CA 92697, USA; (N.C.-S.); (X.L.)
| | - Benoit Petit
- Laboratory of Radiation Oncology, Radiation Oncology Service, Department of Oncology, CHUV, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (B.P.); (J.O.); (P.T.); (A.Q.P.)
| | - Jonathan Ollivier
- Laboratory of Radiation Oncology, Radiation Oncology Service, Department of Oncology, CHUV, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (B.P.); (J.O.); (P.T.); (A.Q.P.)
| | - Virginie Monceau
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), 92260 Fontenay aux Roses, France;
| | - Pelagia Tsoutsou
- Laboratory of Radiation Oncology, Radiation Oncology Service, Department of Oncology, CHUV, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (B.P.); (J.O.); (P.T.); (A.Q.P.)
- Department of Radiation Oncology, Hôpitaux Universitaires Genèvehug (HUG), 1205 Geneva, Switzerland
| | - Ana Quintela Pousa
- Laboratory of Radiation Oncology, Radiation Oncology Service, Department of Oncology, CHUV, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (B.P.); (J.O.); (P.T.); (A.Q.P.)
| | - Xiaomeng Lin
- Department of Radiation Oncology, University of California at Irvine, Irvine, CA 92697, USA; (N.C.-S.); (X.L.)
| | - Charles Limoli
- Department of Radiation Oncology, University of California at Irvine, Irvine, CA 92697, USA; (N.C.-S.); (X.L.)
- Correspondence: (C.L.); (M.-C.V.)
| | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology, Radiation Oncology Service, Department of Oncology, CHUV, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (B.P.); (J.O.); (P.T.); (A.Q.P.)
- Correspondence: (C.L.); (M.-C.V.)
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Nagane M, Yasui H, Kuppusamy P, Yamashita T, Inanami O. DNA damage response in vascular endothelial senescence: Implication for radiation-induced cardiovascular diseases. JOURNAL OF RADIATION RESEARCH 2021; 62:564-573. [PMID: 33912932 PMCID: PMC8273807 DOI: 10.1093/jrr/rrab032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/24/2021] [Indexed: 05/27/2023]
Abstract
A post-exposure cohort study in Hiroshima and Nagasaki reported that low-dose exposure to radiation heightened the risk of cardiovascular diseases (CVD), such as stroke and myocardial infarction, by 14-18% per Gy. Moreover, the risk of atherosclerosis in the coronary arteries reportedly increases with radiation therapy of the chest, including breast and lung cancer treatment. Cellular senescence of vascular endothelial cells (ECs) is believed to play an important role in radiation-induced CVDs. The molecular mechanism of age-related cellular senescence is believed to involve genomic instability and DNA damage response (DDR); the chronic inflammation associated with senescence causes cardiovascular damage. Therefore, vascular endothelial cell senescence is believed to induce the pathogenesis of CVDs after radiation exposure. The findings of several prior studies have revealed that ionizing radiation (IR) induces cellular senescence as well as cell death in ECs. We have previously reported that DDR activates endothelial nitric oxide (NO) synthase, and NO production promotes endothelial senescence. Endothelial NO synthase (eNOS) is a major isoform expressed in ECs that maintains cardiovascular homeostasis. Therefore, radiation-induced NO production, a component of the DDR in ECs, may be involved in CVDs after radiation exposure. In this article, we describe the pathology of radiation-induced CVD and the unique radio-response to radiation exposure in ECs.
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Affiliation(s)
- Masaki Nagane
- Laboratory of Biochemistry, School of Veterinary Medicine, Azabu University, Sagamihara, Kanagawa 252-5201, Japan
| | - Hironobu Yasui
- Laboratory of Radiation Biology, Department of Applied Veterinary Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Periannan Kuppusamy
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire 03756, US
| | - Tadashi Yamashita
- Laboratory of Biochemistry, School of Veterinary Medicine, Azabu University, Sagamihara, Kanagawa 252-5201, Japan
| | - Osamu Inanami
- Laboratory of Radiation Biology, Department of Applied Veterinary Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
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Gaál S, Kahán Z, Paczona V, Kószó R, Drencsényi R, Szabó J, Rónai R, Antal T, Deák B, Varga Z. Deep-inspirational breath-hold (DIBH) technique in left-sided breast cancer: various aspects of clinical utility. Radiat Oncol 2021; 16:89. [PMID: 33985547 PMCID: PMC8117634 DOI: 10.1186/s13014-021-01816-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Studying the clinical utility of deep-inspirational breath-hold (DIBH) in left breast cancer radiotherapy (RT) was aimed at focusing on dosimetry and feasibility aspects. Methods In this prospective trial all enrolled patients went through planning CT in supine position under both DIBH and free breathing (FB); in whole breast irradiation (WBI) cases prone CT was also taken. In 3-dimensional conformal radiotherapy (3DCRT) plans heart, left anterior descending coronary artery (LAD), ipsilateral lung and contralateral breast doses were analyzed. The acceptance of DIBH technique as reported by the patients and the staff was analyzed; post-RT side-effects including radiation lung changes (visual scores and lung density measurements) were collected. Results Among 130 enrolled patients 26 were not suitable for the technique while in 16, heart or LAD dose constraints were not met in the DIBH plans. Among 54 and 34 patients receiving WBI and postmastectomy/nodal RT, respectively with DIBH, mean heart dose (MHD) was reduced to < 50%, the heart V25 Gy to < 20%, the LAD mean dose to < 40% and the LAD maximum dose to about 50% as compared to that under FB; the magnitude of benefit was related to the relative increase of the ipsilateral lung volume at DIBH. Nevertheless, heart and LAD dose differences (DIBH vs. FB) individually varied. Among the WBI cases at least one heart/LAD dose parameter was more favorable in the prone or in the supine FB plan in 15 and 4 cases, respectively; differences were numerically small. All DIBH patients completed the RT, inter-fraction repositioning accuracy and radiation side-effects were similar to that of other breast RT techniques. Both the patients and radiographers were satisfied with the technique. Conclusions DIBH is an excellent heart sparing technique in breast RT, but about one-third of the patients do not benefit from that otherwise laborious procedure or benefit less than from an alternative method. Trial registration: retrospectively registered under ISRCTN14360721 (February 12, 2021) Supplementary information The online version contains supplementary material available at 10.1186/s13014-021-01816-3.
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Affiliation(s)
- Szilvia Gaál
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Viktor Paczona
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Rita Drencsényi
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Judit Szabó
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Ramóna Rónai
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Tímea Antal
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Bence Deák
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
| | - Zoltán Varga
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary.
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18
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Pathomechanisms and therapeutic opportunities in radiation-induced heart disease: from bench to bedside. Clin Res Cardiol 2021; 110:507-531. [PMID: 33591377 PMCID: PMC8055626 DOI: 10.1007/s00392-021-01809-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/16/2021] [Indexed: 12/14/2022]
Abstract
Cancer management has undergone significant improvements, which led to increased long-term survival rates among cancer patients. Radiotherapy (RT) has an important role in the treatment of thoracic tumors, including breast, lung, and esophageal cancer, or Hodgkin's lymphoma. RT aims to kill tumor cells; however, it may have deleterious side effects on the surrounding normal tissues. The syndrome of unwanted cardiovascular adverse effects of thoracic RT is termed radiation-induced heart disease (RIHD), and the risk of developing RIHD is a critical concern in current oncology practice. Premature ischemic heart disease, cardiomyopathy, heart failure, valve abnormalities, and electrical conduct defects are common forms of RIHD. The underlying mechanisms of RIHD are still not entirely clear, and specific therapeutic interventions are missing. In this review, we focus on the molecular pathomechanisms of acute and chronic RIHD and propose preventive measures and possible pharmacological strategies to minimize the burden of RIHD.
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19
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Maeda A, Murakami M, Iwasaki R, Goto S, Kitagawa K, Sakai H, Mori T. Three-dimensional conformal radiation therapy for canine aortic body tumour: 6 cases (2014-2019). J Small Anim Pract 2020; 62:385-390. [PMID: 33300156 DOI: 10.1111/jsap.13241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the feasibility of three-dimensional conformal radiation therapy for canine aortic body tumours. MATERIALS AND METHODS Medical records of dogs that had undergone three-dimensional conformal radiation therapy with presumptive diagnosis of aortic body tumour were reviewed for clinical characteristics, treatment modality and outcomes. RESULTS Eight dogs were diagnosed with aortic body tumour and were treated with three-dimensional conformal radiation therapy. One dog had proliferation of a mass in the right atrium during treatment and died of respiratory distress. Another dog did not undergo follow-up CT to evaluate the treatment response due to the increased blood urea nitrogen values. The remaining 6 dogs were included in the case series. Radiotherapy was performed using a median dose per fraction of 7 Gy (3.3-7.14 Gy), a median of seven divided doses (7-15) and a total median dose of 49 Gy (45-50 Gy). The median number of CT scans during the follow-up period was 5 (range: 3-8 times). CT revealed acute side effects in four dogs-grade 1 effects related to the lung (n = 4) and skin (n = 2). Self-limiting or asymptomatic late side effects (grade 1 lung-related effect) were observed in three dogs. After therapy, one dog demonstrated a complete response, another demonstrated a partial response and the disease remained stable in four animals. The median follow-up period was 514.5 (235-1219) days. After three-dimensional conformal radiation therapy, the aortic body tumour reduced gradually over time without regrowth in all these 6 dogs. CLINICAL SIGNIFICANCE In this small case series, aortic body tumours responded to three-dimensional conformal radiation therapy. Transient and self-limiting side effects of the treatments were common. Further controlled studies are required to prove the effectiveness and the safety of this intervention.
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Affiliation(s)
- A Maeda
- Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Japan
| | - M Murakami
- Laboratory of Veterinary Clinical Oncology, Department of Veterinary Medicine, Gifu University, Gifu5011193, Japan
| | - R Iwasaki
- Animal Medical Center, Gifu University, Gifu5011193, Japan
| | - S Goto
- Animal Medical Center, Gifu University, Gifu5011193, Japan
| | - K Kitagawa
- Department of Small Animal Clinical Science, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, 48824, USA
| | - H Sakai
- Laboratory of Veterinary Pathology, Department of Veterinary Medicine, Gifu University, Gifu, 5011193, Japan
| | - T Mori
- Laboratory of Veterinary Clinical Oncology, Department of Veterinary Medicine, Gifu University, Gifu5011193, Japan.,Center for Highly Advanced Integration of Nano and Life Sciences, Gifu University (G-CHAIN), Gifu, Japan
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20
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Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2020; 40:3297-3317. [PMID: 31504452 DOI: 10.1093/eurheartj/ehz641] [Citation(s) in RCA: 776] [Impact Index Per Article: 194.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/30/2018] [Accepted: 08/26/2019] [Indexed: 02/07/2023] Open
Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for HF symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), left ventricular (LV) filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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Affiliation(s)
- Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany
| | - Rudolf A de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Stefan D Anker
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
| | - Erwan Donal
- Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.,Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore.,University Medical Centre Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.,German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Switzerland
| | - Walter J Paulus
- Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
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21
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Quirk S, Grendarova P, Phan T, Conroy L, Burke B, Long K, Thind K, Cao J, Craighead P, Olivotto IA, Roumeliotis M. A retrospective analysis to demonstrate achievable dosimetry for the left anterior descending artery in left-sided breast cancer patients treated with radiotherapy. Radiother Oncol 2020; 148:167-173. [DOI: 10.1016/j.radonc.2020.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/25/2022]
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22
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Wang B, Wang H, Zhang M, Ji R, Wei J, Xin Y, Jiang X. Radiation-induced myocardial fibrosis: Mechanisms underlying its pathogenesis and therapeutic strategies. J Cell Mol Med 2020; 24:7717-7729. [PMID: 32536032 PMCID: PMC7348163 DOI: 10.1111/jcmm.15479] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/18/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022] Open
Abstract
Radiation-induced myocardial fibrosis (RIMF) is a potentially lethal clinical complication of chest radiotherapy (RT) and a final stage of radiation-induced heart disease (RIHD). RIMF is characterized by decreased ventricular elasticity and distensibility, which can result in decreased ejection fraction, heart failure and even sudden cardiac death. Together, these conditions impair the long-term health of post-RT survivors and limit the dose and intensity of RT required to effectively kill tumour cells. Although the exact mechanisms involving in RIMF are unclear, increasing evidence indicates that the occurrence of RIMF is related to various cells, regulatory molecules and cytokines. However, accurately diagnosing and identifying patients who may progress to RIMF has been challenging. Despite the urgent need for an effective treatment, there is currently no medical therapy for RIMF approved for routine clinical application. In this review, we investigated the underlying pathophysiology involved in the initiation and progression of RIMF before outlining potential preventative and therapeutic strategies to counter this toxicity.
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Affiliation(s)
- Bin Wang
- Department of Radiation OncologyThe First Hospital of Jilin UniversityChangchunChina
- Jilin Provincial Key Laboratory of Radiation Oncology & TherapyThe First Hospital of Jilin UniversityChangchunChina
- NHC Key Laboratory of RadiobiologySchool of Public HealthJilin UniversityChangchunChina
| | - Huanhuan Wang
- Department of Radiation OncologyThe First Hospital of Jilin UniversityChangchunChina
- Jilin Provincial Key Laboratory of Radiation Oncology & TherapyThe First Hospital of Jilin UniversityChangchunChina
- NHC Key Laboratory of RadiobiologySchool of Public HealthJilin UniversityChangchunChina
| | - Mengmeng Zhang
- Phase I Clinical Research CenterThe First Hospital of Jilin UniversityChangchunChina
| | - Rui Ji
- Department of BiologyValencia CollegeOrlandoFLUSA
| | - Jinlong Wei
- Department of Radiation OncologyThe First Hospital of Jilin UniversityChangchunChina
| | - Ying Xin
- Key Laboratory of PathobiologyMinistry of EducationJilin UniversityChangchunChina
| | - Xin Jiang
- Department of Radiation OncologyThe First Hospital of Jilin UniversityChangchunChina
- Jilin Provincial Key Laboratory of Radiation Oncology & TherapyThe First Hospital of Jilin UniversityChangchunChina
- NHC Key Laboratory of RadiobiologySchool of Public HealthJilin UniversityChangchunChina
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23
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Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2020; 22:391-412. [PMID: 32133741 DOI: 10.1002/ejhf.1741] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/30/2018] [Accepted: 08/26/2019] [Indexed: 12/11/2022] Open
Abstract
Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the 'HFA-PEFF diagnostic algorithm'. Step 1 (P=Pre-test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non-cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e'), LV filling pressure estimated using E/e', left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2-4 points) implies diagnostic uncertainty, in which case Step 3 (F1 : Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2 : Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.
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Affiliation(s)
- Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute, Berlin, Germany.,Berlin Institute of Health (BIH), Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany
| | - Rudolf A de Boer
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | - Stefan D Anker
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Charite, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Germany
| | - Erwan Donal
- Cardiology and CIC, IT1414, CHU de Rennes LTSI, Université Rennes-1, INSERM 1099, Rennes, France
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum.,German Center for Cardiovascular Research (DZHK), Berlin, Partner Site, Germany
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hosptal/Ostra, Göteborg, Sweden
| | - Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS, Milan, Italy.,Department of Cardiology, IRCCS Policlinico, San Donato Milanese, Milan, Italy
| | - Carolyn S P Lam
- National Heart Centre, Singapore & Duke-National University of Singapore.,University Medical Centre Groningen, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt.,German Centre for Cardiovascular Research (DZHK), Partner Site Frankfurt, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum
| | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology and Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Adriaan A Voors
- University Medical Centre Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Switzerland
| | - Walter J Paulus
- Department of Physiology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, The Netherlands
| | - Petar Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Serbia
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School; University Hospital "Attikon", Athens, Greece.,University of Cyprus, School of Medicine, Nicosia, Cyprus
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24
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Barlaz Us S, Vezir O, Yildirim M, Bayrak G, Yalin S, Balli E, Yalin AE, Çömelekoğlu Ü. Protective effect of N-acetyl cysteine against radiotherapy-induced cardiac damage. Int J Radiat Biol 2020; 96:661-670. [PMID: 31990607 DOI: 10.1080/09553002.2020.1721605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: Although radiotherapy (RT) is an important component of cancer treatment, it induces adverse tissue reactions in the around of cancer tissue. Therefore, radioprotectives are needed to protect normal tissues. The aim of this study was to investigate the radioprotective effect of N-acetylcysteine (NAC) on RT-induced cardiac damage in rats for the acute term.Materials and methods: The animals were divided into four groups. The rats in control group were injected with saline for 7 d; the rats in NAC group were injected NAC at dose of 240 mg/kg d for 7 d; the rats in RT group were injected with saline for 7 d plus was irradiated 1 h after the last injection and the rats in NAC + RT group were injected with NAC for 7 d and irradiated 1 h after the last NAC dose. The electrocardiogram was recorded and evaluated PR interval, QRS duration, QT interval, T wave alterations and heart rate. Serum interleukin-4, interleukin-6, tumor necrosis factor-alpha, interleukin 1 beta, galectin-3 levels and creatine kinase and creatine kinase isoenzyme-MB activities were determined in all groups. Also, tissue malondialdehyde (MDA) and nitric oxide levels, superoxide dismutase, catalase and glutathione peroxidase activities were determined. In addition, histological changes of heart were evaluated. All measurements were performed 24 h after RT.Results: In the RT group, findings supporting cardiac injury were observed in the electrocardiogram. Also, cytokine levels and oxidative stress were significantly increased. Pretreatment of rats with NAC ameliorated cardiac injury induced by RT.Conclusions: Our findings suggested that NAC may be a potential radioprotector which is capable of preventing cardiac damage.
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Affiliation(s)
- Songul Barlaz Us
- Department of Radiation Oncology, Mersin University, Mersin, Turkey
| | - Ozden Vezir
- Department of Cardiovascular Surgery, Mersin City Hospital, Mersin, Turkey
| | - Metin Yildirim
- Department of Biochemistry, Mersin University, Mersin, Turkey
| | - Gülsen Bayrak
- Department of Histology-Embryology, Mersin University, Mersin, Turkey
| | - Serap Yalin
- Department of Biochemistry, Mersin University, Mersin, Turkey
| | - Ebru Balli
- Department of Histology-Embryology, Mersin University, Mersin, Turkey
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25
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Rárosi F, Boda K, Kahán Z, Varga Z. Decision curve analysis apropos of choice of preferable treatment positioning during breast irradiation. BMC Med Inform Decis Mak 2019; 19:204. [PMID: 31664991 PMCID: PMC6819418 DOI: 10.1186/s12911-019-0927-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Radiotherapy is a standard treatment option for breast cancer, but it may lead to significant late morbidity, including radiation heart damage. Breast irradiation performed individually in the supine or prone position may aid in minimizing the irradiation dose to the heart and LAD coronary artery. A series of CT scans and therapy plans are needed in both positions for the 'gold standard' decision on the preferable treatment position. This method is expensive with respect to technology and physician workload. Our ultimate goal is to develop a predictive tool to identify the preferable treatment position using easily measurable patient characteristics. In this article, we describe the details of how model building and consequently validation of the best model are done. METHODS Different models were used: both logistic regression and multiple linear regressions were used to estimate the LAD mean dose difference (the difference between the mean dose to the LAD in the supine position versus prone position); predicted dose differences were analysed compared to the 'gold standard' values, and the best model was selected accordingly. The final model was checked by random cross-validation. In addition to generally used measures (ROC and Brier score), decision curves were employed to evaluate the performance of the models. RESULTS ROC analysis demonstrated that none of the predictors alone was satisfactory. Multiple logistic regression models and the linear regression model lead to high values of net benefit for a wide range of threshold probabilities. Multiple linear regression seemed to be the most useful model. We also present the results of the random cross-validation for this model (i.e. sensitivity of 80.7% and specificity of 87.5%). CONCLUSIONS Decision curves proved to be useful to evaluate our models. Our results indicate that any of the models could be implemented in clinical practice, but the linear regression model is the most useful model to facilitate the radiation treatment decision. In addition, it is in use in everyday practice in the Department of Oncotherapy, University of Szeged, Hungary.
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Affiliation(s)
- Ferenc Rárosi
- Department of Medical Physics and Informatics, University of Szeged, Korányi fasor 9, Szeged, 6720, Hungary.
| | - Krisztina Boda
- Department of Medical Physics and Informatics, University of Szeged, Korányi fasor 9, Szeged, 6720, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, 6720, Hungary
| | - Zoltán Varga
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, Szeged, 6720, Hungary
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26
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Karam HM, Radwan RR. Metformin modulates cardiac endothelial dysfunction, oxidative stress and inflammation in irradiated rats: A new perspective of an antidiabetic drug. Clin Exp Pharmacol Physiol 2019; 46:1124-1132. [DOI: 10.1111/1440-1681.13148] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/16/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Heba M. Karam
- Drug Radiation Research Department National Center for Radiation Research and Technology (NCRRT) Egyptian Atomic Energy Authority (EAEA) Nasr City Cairo Egypt
| | - Rasha R. Radwan
- Drug Radiation Research Department National Center for Radiation Research and Technology (NCRRT) Egyptian Atomic Energy Authority (EAEA) Nasr City Cairo Egypt
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27
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Wang H, Wei J, Zheng Q, Meng L, Xin Y, Yin X, Jiang X. Radiation-induced heart disease: a review of classification, mechanism and prevention. Int J Biol Sci 2019; 15:2128-2138. [PMID: 31592122 PMCID: PMC6775290 DOI: 10.7150/ijbs.35460] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
With the increasing incidence of thoracic tumors, radiation therapy (RT) has become an important component of comprehensive treatment. RT improves survival in many cancers, but it involves some inevitable complications. Radiation-induced heart disease (RIHD) is one of the most serious complications. RIHD comprises a spectrum of heart disease including cardiomyopathy, pericarditis, coronary artery disease, valvular heart disease and conduction system abnormalities. There are numerous clinical manifestations of RIHD, such as chest pain, palpitation, and dyspnea, even without obvious symptoms. Based on previous studies, the pathogenesis of RIHD is related to the production and effects of various cytokines caused by endothelial injury, inflammatory response, and oxidative stress (OS). Therefore, it is of great importance for clinicians to identify the mechanism and propose interventions for the prevention of RIHD.
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Affiliation(s)
- Heru Wang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, 130021, China.,Department of Cardiology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlong Wei
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Qingshuang Zheng
- Department of Cardiology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Lingbin Meng
- Department of Internal Medicine, Florida Hospital, Orlando, FL 32804,USA
| | - Ying Xin
- Key Laboratory of Pathobiology, Ministry of Education, Jilin University, Changchun 130021, China
| | - Xia Yin
- Department of Cardiology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xin Jiang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, 130021, China
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Sárközy M, Gáspár R, Zvara Á, Kiscsatári L, Varga Z, Kővári B, Kovács MG, Szűcs G, Fábián G, Diószegi P, Cserni G, Puskás LG, Thum T, Kahán Z, Csont T, Bátkai S. Selective Heart Irradiation Induces Cardiac Overexpression of the Pro-hypertrophic miR-212. Front Oncol 2019; 9:598. [PMID: 31380269 PMCID: PMC6646706 DOI: 10.3389/fonc.2019.00598] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022] Open
Abstract
Background: A deleterious, late-onset side effect of thoracic radiotherapy is the development of radiation-induced heart disease (RIHD). It covers a spectrum of cardiac pathology including also heart failure with preserved ejection fraction (HFpEF) characterized by left ventricular hypertrophy (LVH) and diastolic dysfunction. MicroRNA-212 (miR-212) is a crucial regulator of pathologic LVH via FOXO3-mediated pathways in pressure-overload-induced heart failure. We aimed to investigate whether miR-212 and its selected hypertrophy-associated targets play a role in the development of RIHD. Methods: RIHD was induced by selective heart irradiation (50 Gy) in a clinically relevant rat model. One, three, and nineteen weeks after selective heart irradiation, transthoracic echocardiography was performed to monitor cardiac morphology and function. Cardiomyocyte hypertrophy and fibrosis were assessed by histology at week 19. qRT-PCR was performed to measure the gene expression changes of miR-212 and forkhead box O3 (FOXO3) in all follow-up time points. The cardiac transcript level of other selected hypertrophy-associated targets of miR-212 including extracellular signal-regulated kinase 2 (ERK2), myocyte enhancer factor 2a (MEF2a), AMP-activated protein kinase, (AMPK), heat shock protein 40 (HSP40), sirtuin 1, (SIRT1), calcineurin A-alpha and phosphatase and tensin homolog (PTEN) were also measured at week 19. Cardiac expression of FOXO3 and phospho-FOXO3 were investigated at the protein level by Western blot at week 19. Results: In RIHD, diastolic dysfunction was present at every time point. Septal hypertrophy developed at week 3 and a marked LVH with interstitial fibrosis developed at week 19 in the irradiated hearts. In RIHD, cardiac miR-212 was overexpressed at week 3 and 19, and FOXO3 was repressed at the mRNA level only at week 19. In contrast, the total FOXO3 protein level failed to decrease in response to heart irradiation at week 19. Other selected hypertrophy-associated target genes failed to change at the mRNA level in RIHD at week 19. Conclusions: LVH in RIHD was associated with cardiac overexpression of miR-212. However, miR-212 seems to play a role in the development of LVH via FOXO3-independent mechanisms in RIHD. As a central regulator of pathologic remodeling, miR-212 might become a novel target for RIHD-induced LVH and heart failure.
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Affiliation(s)
- Márta Sárközy
- Metabolic Diseases and Cell Signaling Group, Department of Biochemistry, Interdisciplinary Centre of Excellence, University of Szeged, Szeged, Hungary
| | - Renáta Gáspár
- Metabolic Diseases and Cell Signaling Group, Department of Biochemistry, Interdisciplinary Centre of Excellence, University of Szeged, Szeged, Hungary
| | - Ágnes Zvara
- Laboratory for Functional Genomics, Biological Research Center of the Hungarian Academy of Sciences, Institute of Genetics, Szeged, Hungary
| | - Laura Kiscsatári
- Department of Oncotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Varga
- Department of Oncotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Bence Kővári
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Mónika G Kovács
- Metabolic Diseases and Cell Signaling Group, Department of Biochemistry, Interdisciplinary Centre of Excellence, University of Szeged, Szeged, Hungary
| | - Gergő Szűcs
- Metabolic Diseases and Cell Signaling Group, Department of Biochemistry, Interdisciplinary Centre of Excellence, University of Szeged, Szeged, Hungary
| | - Gabriella Fábián
- Department of Oncotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Petra Diószegi
- Metabolic Diseases and Cell Signaling Group, Department of Biochemistry, Interdisciplinary Centre of Excellence, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - László G Puskás
- Laboratory for Functional Genomics, Biological Research Center of the Hungarian Academy of Sciences, Institute of Genetics, Szeged, Hungary
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hanover Medical School, Hanover, Germany
| | - Zsuzsanna Kahán
- Department of Oncotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Csont
- Metabolic Diseases and Cell Signaling Group, Department of Biochemistry, Interdisciplinary Centre of Excellence, University of Szeged, Szeged, Hungary
| | - Sándor Bátkai
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hanover Medical School, Hanover, Germany
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MitraClip for radiotherapy-related mitral valve regurgitation. Hellenic J Cardiol 2019; 60:232-238. [DOI: 10.1016/j.hjc.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 01/09/2023] Open
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Boulet J, Peña J, Hulten EA, Neilan TG, Dragomir A, Freeman C, Lambert C, Hijal T, Nadeau L, Brophy JM, Mousavi N. Statin Use and Risk of Vascular Events Among Cancer Patients After Radiotherapy to the Thorax, Head, and Neck. J Am Heart Assoc 2019; 8:e005996. [PMID: 31213106 PMCID: PMC6662340 DOI: 10.1161/jaha.117.005996] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study aimed to explore whether statins reduce radiation‐induced vascular complications in cancer patients postradiotherapy to the thorax, head, and neck. Methods and Results We conducted a retrospective cohort study within a provincial linked database of 5718 cardiac patients with thorax and head or neck cancer having undergone radiotherapy between 2000 and 2011. One thousand five hundred fifty‐two patients were identified as nonstatin users and 4166 as statin users. The primary outcome of interest was the composite of cerebrovascular (transient ischemic attack, and fatal or nonfatal stroke) or cardiovascular events (fatal or nonfatal myocardial infarction). Time‐dependent Cox proportional hazard analyses were performed. The crude event rate was 10.31% for nonusers and 9.03% for statin users (hazard ratio of 0.92 [95% CI 0.76–1.10, P=0.3451]), over a mean time to event/censoring of 534±687 days for nonusers and 594±706 days for the statin users. After adjusting for age, sex, prior history of stroke/transient ischemic attack or myocardial infarction, diabetes mellitus, dyslipidemia, atrial fibrillation, chronic kidney disease, heart failure, and hypertension, statin use postradiotherapy was associated with a nonsignificant 15% relative risk reduction, but a strong trend toward reducing the primary outcome (hazard ratio=0.85 95% CI 0.69–1.04, P=0.0811). The use of statins was associated with a significant reduction of 32% for the outcome of stroke alone (hazard ratio=0.68, 95% CI 0.48–0.98, P=0.0368). Conclusions Statin use post radiation therapy was associated with a significant reduction in stroke, with a trend toward significantly reducing cardiovascular and cerebrovascular events.
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Affiliation(s)
- Jacinthe Boulet
- 1 Department of Internal Medicine McGill University Health Centre Montreal Quebec Canada
| | - Jessica Peña
- 5 Dalio Institute of Cardiovascular Imaging Weill Cornell Medicine Weill Cornell University New York NY
| | - Edward A Hulten
- 6 Division of Cardiology Walter Reed National Military Medical Centre Washington DC
| | - Tomas G Neilan
- 7 Cardio-Oncology Program Division of Cardiology Massachusetts General Hospital Boston MA
| | - Alice Dragomir
- 2 Division of Urology Surgical Research McGill University Health Centre Montreal Quebec Canada
| | - Carolyn Freeman
- 3 Division of Radiation Oncology McGill University Health Centre Montreal Quebec Canada
| | - Christine Lambert
- 3 Division of Radiation Oncology McGill University Health Centre Montreal Quebec Canada
| | - Tarek Hijal
- 3 Division of Radiation Oncology McGill University Health Centre Montreal Quebec Canada
| | - Lyne Nadeau
- 4 Division of Clinical Epidemiology Department of Medicine McGill University Health Centre Montreal Quebec Canada
| | - James M Brophy
- 4 Division of Clinical Epidemiology Department of Medicine McGill University Health Centre Montreal Quebec Canada.,8 Departments of Cardiology and Epidemiology, Biostatistics and Occupational Health McGill University Montreal Quebec Canada
| | - Negareh Mousavi
- 4 Division of Clinical Epidemiology Department of Medicine McGill University Health Centre Montreal Quebec Canada
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Cardiovascular Damage Induced by Radiotherapy. CARDIOVASCULAR COMPLICATIONS IN CANCER THERAPY 2019. [DOI: 10.1007/978-3-319-93402-0_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Portaluri M, Petruzzelli MF, Tramacere F, Andreassi MG. B-type natriuretic peptide plasma level in 5-year breast cancer survivors after radiotherapy. Int J Radiat Biol 2018; 95:201-206. [PMID: 30431375 DOI: 10.1080/09553002.2019.1542183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Left-sided breast cancer patients treated with radiotherapy (RT) are at risk for late radiation-induced cardiovascular complications. AIM The aim of this study was to investigate the BNP plasma levels in long-term breast cancer survivors who received only RT as well to assess whether cardiac dose was associated with BNP values. METHODS Plasma samples for BNP measurement were repeated in 29 patients (63 ± 11 years) who were alive at 5 years after radiotherapy, free of heart disease and available to provide new blood sample. All patients had BNP measurements at baseline. The ΔBNP was measured to analyze the role of marker variations. No patients received chemotherapy. RESULTS The mean cardiac and ventricle dose were 2.1 ± 1.0 (range 0.02-4.5) Gy and 3.0 ± 1.7 (range 0.02-7.6), respectively. Median value of BNP was 47 pg/mL (interquartile ranges, 26-58.2 pg/mL) at baseline, and 34 pg/mL (interquartile ranges, 17.5-54 pg/mL) at 5 years after radiotherapy. There was no significantly different between two measurements (p = ns). Fifteen (52%) reported an improvement in BNP levels, 1 (3%) no changes and 13 (45%) reported a worsening. There was no correlation between ΔBNP and age (p = ns). When patients were stratified according to the median value of dose-volume data, ΔBNP was significantly higher in patients with increased cardiac Dmean (p = .02) and left ventricle Dmean (p = .009). CONCLUSION At 5 years after radiotherapy, median plasma BNP levels remained within the normal range, but the delta-BNP levels are directly related to the heart and ventricular dose received.
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Nabiałek-Trojanowska I, Lewicka E, Wrona A, Kaleta AM, Lewicka-Potocka Z, Raczak G, Dziadziuszko R. Cardiovascular complications after radiotherapy. Cardiol J 2018; 27:836-847. [PMID: 30338841 DOI: 10.5603/cj.a2018.0120] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/07/2018] [Accepted: 10/11/2018] [Indexed: 12/13/2022] Open
Abstract
Over the past decades, effective cancer therapies have resulted in a significant improvement in the survival rates for a number of cancers and an increase in the number of cancer survivors. Radiation therapy is widely used in the treatment of cancer, and it can induce various cardiotoxicities that differ considerably from chemotherapy-induced cardiotoxicity. They occur primarily as late radiation-induced complications, several years from the end of anticancer treatment and present as coronary artery disease, heart failure, pericardial disease, valvular heart disease and arrhythmias. Patients who recovered from cancer disease suffer from cardiac complications of anticancer treatment, it affects the quality of their lives and life expectancy, especially if the diagnosis is delayed. These patients may present distinct symptoms of cardiac injury, resulting from radiation-induced neurotoxicity and altered pain perception, which makes diagnosis difficult. This review highlights the need for a screening programme for patients who have undergone radiation therapy and which will subsequently have a potentially profound impact on morbidity and mortality.
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Affiliation(s)
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Anna Wrona
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Poland, Dębinki 7,, 80-211 Gdańsk, Poland
| | - Anna M Kaleta
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | | | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Poland, Dębinki 7,, 80-211 Gdańsk, Poland
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Piroth MD, Baumann R, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Krug D, Röser A, Sedlmayer F, Souchon R, Wenz F, Sauer R. Heart toxicity from breast cancer radiotherapy : Current findings, assessment, and prevention. Strahlenther Onkol 2018; 195:1-12. [PMID: 30310926 PMCID: PMC6329735 DOI: 10.1007/s00066-018-1378-z] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022]
Abstract
Background Late cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures. Methods A literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed. Results Based on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%. Conclusion In addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians’ aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician’s hand. The risk of breast cancer-specific mortality and a patient’s cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.
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Affiliation(s)
- Marc D. Piroth
- Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - René Baumann
- St. Marien-Krankenhaus Siegen, Siegen, Germany
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Wilfried Budach
- Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jürgen Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - Petra Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | | | - Wulf Haase
- formerly St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | | | - Thomas Hehr
- Marienhospital Stuttgart, Stuttgart, Germany
| | - David Krug
- University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Arnd Röser
- Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Felix Sedlmayer
- Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | | | - Frederik Wenz
- University Hospital Mannheim, Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Rolf Sauer
- University Hospital Erlangen, Erlangen, Germany
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Marinko T. Pericardial disease after breast cancer radiotherapy. Radiol Oncol 2018; 53:1-5. [PMID: 30840590 PMCID: PMC6411022 DOI: 10.2478/raon-2018-0035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 05/12/2018] [Indexed: 12/25/2022] Open
Abstract
Background Breast cancer is the second most common cancer worldwide. Thanks to the modern oncological treatments, disease specific survival has improved throughout the last decades. The number of breast cancer survivors has been increasing, and more and more attention has been paid to the breast cancer treatment side effects. Whereas there are many data regarding ischemic heart disease after radiotherapy for breast cancer, there is not much data in the literature about the incidence and clinical meaning of pericardial disease after breast cancer radiotherapy. Conclusions Although radiation-induced pericarditis is the earliest form of radiation-induced cardiovascular disease after irradiation of the heart, it seems that in clinical practice, especially by using modern radiotherapy treatment techniques, it is underdiagnosed because patients are mostly asymptomatic. In some cases, especially in its late form and after multimodal systemic oncological treatment in combination with radiotherapy, it could be presented in severe form and life threatening. Treatment modalities for radiation-induced pericardial diseases are the same as in the non-irradiated population, but in the irradiated patients, surgery may be difficult.
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Affiliation(s)
- Tanja Marinko
- Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia
- Tanja Marinko, M.D., Ph.D., Institute of Oncology Ljubljana, Zaloška cesta 2, SI-1000 Ljubljana, Slovenia. Phone: +386 1 5879 515; Fax: +386 1 5879 400
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Zhao J, Zhi Z, Zhang M, Li Q, Li J, Wang X, Ma C. Predictive value of single nucleotide polymorphisms in XRCC1 for radiation-induced normal tissue toxicity. Onco Targets Ther 2018; 11:3901-3918. [PMID: 30013370 PMCID: PMC6039069 DOI: 10.2147/ott.s156175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose X-Ray Repair Cross Complementing 1 (XRCC1) functioning in the base excision repair pathway plays an important role in the repair of DNA single-strand breaks caused by ionizing radiation. The relationship between XRCC1 polymorphisms and the risk of radiation-induced side effects on normal tissues remains controversial. Therefore, we performed a comprehensive meta-analysis to elucidate these associations. Materials and methods A systematic literature search was carried out in PubMed, Medline (Ovid), Embase, Web of Science, Cochrane database, and the references of relevant studies. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were calculated to evaluate the strength of the association. Results A total of 40 studies including 6,682 patients were eventually identified in this meta-analysis. Pooled results suggested that rs25487 Arg399Gln polymorphism significantly increased the risk of acute radiation-induced side effects (OR=1.29, 95% CI: 1.10–1.52, P=0.002), especially acute mucositis (OR=1.91, 95% CI: 1.17–3.11, P=0.01) and acute gastrointestinal and genitourinary toxicity (OR=1.49, 95% CI: 1.04–2.11, P=0.03). Furthermore, patients who received head and neck irradiation with rs25487 Arg399Gln polymorphism were more likely to experience radiotherapy (RT)-induced side effects (OR=1.46, 95% CI: 1.12–1.90, P=0.005). However, no statistically significant correlations were identified between rs25487 polymorphism and any late side effects and other irradiation areas. Likewise, no significant associations were detected between rs25489, rs1799782, or rs3213245 polymorphism and RT-induced toxicity. Conclusion Our meta-analysis demonstrated that XRCC1 rs25487 Arg399Gln polymorphism had a significant predictive value and might predict a risk of severely acute RT-induced adverse effects, especially in acute mucositis and acute gastrointestinal and genitourinary toxicity, or in patients with head and neck irradiation. However, large-scale and well-designed studies are required to further evaluate the predictive value of XRCC1 variations on radiation-induced side effects in order to identify radiosensitive patients and predict radiotoxicity.
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Affiliation(s)
- Jing Zhao
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Zheng Zhi
- Department of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei 050200, China
| | - Ming Zhang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Qingxia Li
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Jing Li
- Department of Clinical laboratory, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Xiao Wang
- Department of Plastic Surgery, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Chunling Ma
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
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Sievert W, Stangl S, Steiger K, Multhoff G. Improved Overall Survival of Mice by Reducing Lung Side Effects After High-Precision Heart Irradiation Using a Small Animal Radiation Research Platform. Int J Radiat Oncol Biol Phys 2018; 101:671-679. [DOI: 10.1016/j.ijrobp.2018.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/14/2017] [Accepted: 02/07/2018] [Indexed: 12/27/2022]
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Nagane M, Kuppusamy ML, An J, Mast JM, Gogna R, Yasui H, Yamamori T, Inanami O, Kuppusamy P. Ataxia-Telangiectasia Mutated (ATM) Kinase Regulates eNOS Expression and Modulates Radiosensitivity in Endothelial Cells Exposed to Ionizing Radiation. Radiat Res 2018; 189:519-528. [PMID: 29474156 DOI: 10.1667/rr14781.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Endothelial nitric oxide synthase (eNOS), a constitutive enzyme expressed in vascular endothelial cells, is the main source of nitric oxide (NO), which plays key roles in diverse biological functions, including regulation of vascular tone. Exposure to radiation has been known to generate nitric oxide from eNOS; however, the precise mechanism of its generation and function is not known. The goal of this study was to determine the involvement of radiation-induced DNA damage response (DDR) on eNOS transcription and its effect on cell survival after irradiation. Irradiated bovine aortic endothelial cells showed increased eNOS transcription and NO generation through upregulation of ataxia-telangiectasia mutated (ATM) kinase. Radiation exposure induced NO inhibited cell death, as well as induced cellular senescence postirradiation. This study established that radiation-induced DDR uses ATM kinase to upregulate eNOS transcription and NO generation, leading to cellular senescence, which may play a critical role in radiation-mediated cardiovascular injury.
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Affiliation(s)
- Masaki Nagane
- a Department of Radiology, The Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire 03756.,b Laboratory of Radiation Biology, Department of Applied Veterinary Sciences, Division of Veterinary Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan.,c Laboratory of Biochemistry, School of Veterinary Medicine, Azabu University, Sagamihara 252-5201, Japan
| | - M Lakshmi Kuppusamy
- a Department of Radiology, The Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire 03756
| | - Jennifer An
- a Department of Radiology, The Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire 03756
| | - Jesse M Mast
- a Department of Radiology, The Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire 03756
| | - Rajan Gogna
- a Department of Radiology, The Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire 03756.,d Champalimaud Centre for the Unknown, 1400-038 Lisbon, Portugal
| | - Hironobu Yasui
- b Laboratory of Radiation Biology, Department of Applied Veterinary Sciences, Division of Veterinary Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan
| | - Tohru Yamamori
- b Laboratory of Radiation Biology, Department of Applied Veterinary Sciences, Division of Veterinary Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan
| | - Osamu Inanami
- b Laboratory of Radiation Biology, Department of Applied Veterinary Sciences, Division of Veterinary Medicine, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan
| | - Periannan Kuppusamy
- a Department of Radiology, The Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire 03756
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Boaventura P, Durães C, Mendes A, Costa NR, Chora I, Ferreira S, Araújo E, Lopes P, Rosa G, Marques P, Tavares S, Chaves V, Bettencourt P, Oliveira I, Costa F, Ramos I, Teles MJ, Guimarães JT, Sobrinho-Simões M, Soares P. Is Low-Dose Radiation Exposure a Risk Factor for Atherosclerotic Disease? Radiat Res 2018; 189:418-424. [PMID: 29461943 DOI: 10.1667/rr14942.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Nontargeted late effects of radiation include an increased risk of cardiovascular disease, although this is still debatable in the context of low-dose radiation. Tinea capitis patients treated in childhood with X rays to induce scalp epilation received a low dose of radiation to their carotids. To better clarify this issue, we evaluated carotid atherosclerosis in a cohort of such patients treated in 1950-1963 in Portugal. A group of 454 individuals randomly chosen from previously observed Portuguese tinea capitis patients and a control group mainly composed of their spouses (n = 280) were enrolled. Cardiovascular risk factors such as waist circumference, body mass index, blood pressure and tobacco consumption, as well as biochemical measurements were obtained. Ultrasound imaging of carotid arteries for intima media thickness and stenosis evaluation were performed according to a standardized protocol. In comparison to the control group, the irradiated cohort members were significantly older, more frequently never smokers, hypertensive, and presented higher glycated hemoglobin and alkaline phosphatase levels. In addition, the irradiated cohort showed a higher frequency of carotid stenosis ≥30% than the nonirradiated group (13.9% vs. 10.7%), although this was not significant ( P = 0.20). Stenosis was ≥50% in 2.9% of the irradiated group and 0.4% of the nonirradiated group ( P = 0.02). Likewise, the frequency of intima media thickness ≥1 mm was significantly higher in the irradiated group (16.8% vs. 10.7%; P = 0.02). Multivariate analysis, including other cardiovascular risk factors, showed that exposure to low-dose radiation increased the risk of carotid stenosis by ≥50% [odds ratio (OR) = 8.85; P = 0.04] and intima media thickness by ≥1 mm (OR = 1.82; P = 0.02). These findings confirm that low-dose exposure is a risk factor of carotid atherosclerotic disease.
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Affiliation(s)
- Paula Boaventura
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S)
| | - Cecília Durães
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S)
| | - Adélia Mendes
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S)
| | - Natália Rios Costa
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S)
| | | | | | | | | | | | | | | | | | - Paulo Bettencourt
- c S. João Hospital, Porto.,d Department of Pathology, Faculty of Medicine of the University of Porto
| | | | | | - Isabel Ramos
- c S. João Hospital, Porto.,e Faculty of Medicine of the University of Porto
| | - Maria José Teles
- c S. João Hospital, Porto.,e Faculty of Medicine of the University of Porto
| | | | - Manuel Sobrinho-Simões
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S).,c S. João Hospital, Porto.,d Department of Pathology, Faculty of Medicine of the University of Porto.,e Faculty of Medicine of the University of Porto
| | - Paula Soares
- a Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP).,b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S).,c S. João Hospital, Porto.,e Faculty of Medicine of the University of Porto
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Walaszczyk A, Szołtysek K, Jelonek K, Polańska J, Dörr W, Haagen J, Widłak P, Gabryś D. Heart irradiation reduces microvascular density and accumulation of HSPA1 in mice. Strahlenther Onkol 2017; 194:235-242. [PMID: 29063166 PMCID: PMC5847036 DOI: 10.1007/s00066-017-1220-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Improvement of radiotherapy techniques reduces the exposure of normal tissues to ionizing radiation. However, the risk of radiation-related late effects remains elevated. In the present study, we investigated long-term effects of radiation on heart muscle morphology. MATERIALS AND METHODS We established a mouse model to study microvascular density (MVD), deposition of collagen fibers, and changes in accumulation of heat shock 70 kDa protein 1 (HSPA1) in irradiated heart tissue. Hearts of C57BL/6 mice received a single dose of X‑ray radiation in the range 0.2-16 Gy. Analyses were performed 20, 40, and 60 weeks after irradiation. RESULTS Reduction in MD was revealed as a long-term effect observed 20-60 weeks after irradiation. Moreover, a significant and dose-dependent increase in accumulation of HSPA1, both cytoplasmic and nuclear, was observed in heart tissues collected 20 weeks after irradiation. We also noticed an increase in collagen deposition in hearts treated with higher doses. CONCLUSIONS This study shows that some changes induced by radiation in the heart tissue, such as reduction in microvessel density, increase in collagen deposition, and accumulation of HSPA1, are observed as long-term effects which might be associated with late radiation cardiotoxicity.
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Affiliation(s)
- Anna Walaszczyk
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Katarzyna Szołtysek
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Karol Jelonek
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | | | - Wolfgang Dörr
- Department of Radiotherapy and Radiooncology, Medical Faculty Carl Gustav Carus, University of Technology, Dresden, Germany.,Department of Radiation Oncology, Applied and Translational Radiobiology (ATRAB), Medical University Vienna, Vienna, Austria
| | - Julia Haagen
- Department of Radiotherapy and Radiooncology, Medical Faculty Carl Gustav Carus, University of Technology, Dresden, Germany
| | - Piotr Widłak
- Center for Translational Research and Molecular Biology of Cancer, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Dorota Gabryś
- Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland.
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Takx RAP, Vliegenthart R, Schoepf UJ, Pilz LR, Schoenberg SO, Morris PB, Henzler T, Apfaltrer P. Coronary artery calcium in breast cancer survivors after radiation therapy. Int J Cardiovasc Imaging 2017; 33:1425-1431. [DOI: 10.1007/s10554-017-1119-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/18/2017] [Indexed: 11/25/2022]
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Zhuang XF, Yang YM, Sun XL, Liao ZK, Huang J. Late onset radiation-induced constrictive pericarditis and cardiomyopathy after radiotherapy: A case report. Medicine (Baltimore) 2017; 96:e5932. [PMID: 28151876 PMCID: PMC5293439 DOI: 10.1097/md.0000000000005932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Radiation-induced heart disease (RIHD) is a serious side effect of cancer treatment, including coronary artery disease, valvular cardiac dysfunction, cardiomyopathy, aortopathy, and chronic constrictive pericarditis. Herein, this case we present was diagnosed as radiation-induced constrictive pericarditis and cardiomyopathy by means of cardiac magnetic resonance (CMR) and transthoracic echocardiogram, finally confirmed by pathology after performing heart transplant operation. CONCLUSIONS This case supports a notion that RIHD often causes multiple heart impairment and CMR is helpful to diagnose cardiomyopathy after radiation.
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Affiliation(s)
| | | | | | - Zhong-kai Liao
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Cuomo JR, Sharma GK, Conger PD, Weintraub NL. Novel concepts in radiation-induced cardiovascular disease. World J Cardiol 2016; 8:504-519. [PMID: 27721934 PMCID: PMC5039353 DOI: 10.4330/wjc.v8.i9.504] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/14/2016] [Accepted: 07/29/2016] [Indexed: 02/06/2023] Open
Abstract
Radiation-induced cardiovascular disease (RICVD) is the most common nonmalignant cause of morbidity and mortality among cancer survivors who have undergone mediastinal radiation therapy (RT). Cardiovascular complications include effusive or constrictive pericarditis, cardiomyopathy, valvular heart disease, and coronary/vascular disease. These are pathophysiologically distinct disease entities whose prevalence varies depending on the timing and extent of radiation exposure to the heart and great vessels. Although refinements in RT dosimetry and shielding will inevitably limit future cases of RICVD, the increasing number of long-term cancer survivors, including those treated with older higher-dose RT regimens, will ensure a steady flow of afflicted patients for the foreseeable future. Thus, there is a pressing need for enhanced understanding of the disease mechanisms, and improved detection methods and treatment strategies. Newly characterized mechanisms responsible for the establishment of chronic fibrosis, such as oxidative stress, inflammation and epigenetic modifications, are discussed and linked to potential treatments currently under study. Novel imaging modalities may serve as powerful screening tools in RICVD, and recent research and expert opinion advocating their use is introduced. Data arguing for the aggressive use of percutaneous interventions, such as transcutaneous valve replacement and drug-eluting stents, are examined and considered in the context of prior therapeutic approaches. RICVD and its treatment options are the subject of a rich and dynamic body of research, and patients who are at risk or suffering from this disease will benefit from the care of physicians with specialty expertise in the emerging field of cardio-oncology.
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Affiliation(s)
- Jason R Cuomo
- Jason R Cuomo, Neal L Weintraub, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States
| | - Gyanendra K Sharma
- Jason R Cuomo, Neal L Weintraub, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States
| | - Preston D Conger
- Jason R Cuomo, Neal L Weintraub, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States
| | - Neal L Weintraub
- Jason R Cuomo, Neal L Weintraub, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States
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Kiscsatári L, Varga Z, Schally AV, Gáspár R, Nagy CT, Giricz Z, Ferdinandy P, Fábián G, Kahán Z, Görbe A. Protection of neonatal rat cardiac myocytes against radiation-induced damage with agonists of growth hormone-releasing hormone. Pharmacol Res 2016; 111:859-866. [PMID: 27480202 DOI: 10.1016/j.phrs.2016.07.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/05/2016] [Accepted: 07/25/2016] [Indexed: 12/15/2022]
Abstract
Despite the great clinical significance of radiation-induced cardiac damage, experimental investigation of its mechanisms is an unmet need in medicine. Beneficial effects of growth hormone-releasing hormone (GHRH) agonists in regeneration of the heart have been demonstrated. The aim of this study was the evaluation of the potential of modern GHRH agonistic analogs in prevention of radiation damage in an in vitro cardiac myocyte-based model. Cultures of cardiac myocytes isolated from newborn rats (NRVM) were exposed to a radiation dose of 10Gy. The effects of the agonistic analogs, JI-34 and MR-356, of human GHRH on cell viability, proliferation, their mechanism of action and the protein expression of the GHRH/SV1 receptors were studied. JI-34 and MR-356, had no effect on cell viability or proliferation in unirradiated cultures. However, in irradiated cells JI-34 showed protective effects on cell viability at concentrations of 10 and 100nM, and MR-356 at 500nM; but no such protective effect was detected on cell proliferation. Both agonistic analogs decreased radiation-induced ROS level and JI-34 interfered with the activation of SAFE/RISK pathways. Using Western blot analysis, a 52kDa protein isoform of GHRHR was detected in the samples in both irradiated and unirradiated cells. Since GHRH agonistic analogs, JI-34 and MR-356 alleviated radiation-induced damage of cardiac myocytes, they should be tested in vivo as potential protective agents against radiogenic heart damage.
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Affiliation(s)
- Laura Kiscsatári
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Varga
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Andrew V Schally
- Veterans Affairs Medical Center, Miami FL, USA and Departments of Pathology and Medicine, Divisions of Hematology/Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Renáta Gáspár
- Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged, Hungary; Pharmahungary Group, Szeged, Hungary
| | - Csilla Terézia Nagy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Zoltán Giricz
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Péter Ferdinandy
- Pharmahungary Group, Szeged, Hungary; Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Gabriella Fábián
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Anikó Görbe
- Cardiovascular Research Group, Department of Biochemistry, University of Szeged, Szeged, Hungary; Pharmahungary Group, Szeged, Hungary; Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary.
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Blanck O, Ipsen S, Chan MK, Bauer R, Kerl M, Hunold P, Jacobi V, Bruder R, Schweikard A, Rades D, Vogl TJ, Kleine P, Bode F, Dunst J. Treatment Planning Considerations for Robotic Guided Cardiac Radiosurgery for Atrial Fibrillation. Cureus 2016; 8:e705. [PMID: 27588226 PMCID: PMC4999353 DOI: 10.7759/cureus.705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose Robotic guided stereotactic radiosurgery has recently been investigated for the treatment of atrial fibrillation (AF). Before moving into human treatments, multiple implications for treatment planning given a potential target tracking approach have to be considered. Materials & Methods Theoretical AF radiosurgery treatment plans for twenty-four patients were generated for baseline comparison. Eighteen patients were investigated under ideal tracking conditions, twelve patients under regional dose rate (RDR = applied dose over a certain time window) optimized conditions (beam delivery sequence sorting according to regional beam targeting), four patients under ultrasound tracking conditions (beam block of the ultrasound probe) and four patients with temporary single fiducial tracking conditions (differential surrogate-to-target respiratory and cardiac motion). Results With currently known guidelines on dose limitations of critical structures, treatment planning for AF radiosurgery with 25 Gy under ideal tracking conditions with a 3 mm safety margin may only be feasible in less than 40% of the patients due to the unfavorable esophagus and bronchial tree location relative to the left atrial antrum (target area). Beam delivery sequence sorting showed a large increase in RDR coverage (% of voxels having a larger dose rate for a given time window) of 10.8-92.4% (median, 38.0%) for a 40-50 min time window, which may be significant for non-malignant targets. For ultrasound tracking, blocking beams through the ultrasound probe was found to have no visible impact on plan quality given previous optimal ultrasound window estimation for the planning CT. For fiducial tracking in the right atrial septum, the differential motion may reduce target coverage by up to -24.9% which could be reduced to a median of -0.8% (maximum, -12.0%) by using 4D dose optimization. The cardiac motion was also found to have an impact on the dose distribution, at the anterior left atrial wall; however, the results need to be verified. Conclusion Robotic AF radiosurgery with 25 Gy may be feasible in a subgroup of patients under ideal tracking conditions. Ultrasound tracking was found to have the lowest impact on treatment planning and given its real-time imaging capability should be considered for AF robotic radiosurgery. Nevertheless, advanced treatment planning using RDR or 4D respiratory and cardiac dose optimization may be still advised despite using ideal tracking methods.
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Affiliation(s)
- Oliver Blanck
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Saphir Radiosurgery Center, Frankfurt and Güstrow, Germany
| | - Svenja Ipsen
- Robotics and Cognitive Systems, University of Lübeck
| | - Mark K Chan
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Department for Radiation Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Ralf Bauer
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany ; Department for Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Switzerland
| | - Matthias Kerl
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany ; Radiology, Darmstadt, Germany
| | - Peter Hunold
- Clinic for Radiology and Nuclear Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Volkmar Jacobi
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany
| | - Ralf Bruder
- Institute for Robotics and Cognitive Systems, University of Lubeck
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Institute for Robotics and Cognitive Systems, University of Lubeck
| | - Dirk Rades
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Thomas J Vogl
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany
| | - Peter Kleine
- Department for Thoracic, Cardiac and Thoracic Vascular Surgery, University Clinic Frankfurt, Germany
| | - Frank Bode
- Cardiology Department, Sana Clinic Oldenburg in Holstein
| | - Jürgen Dunst
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Department for Radiation Oncology, University Medical Center Copenhagen, Denmark
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47
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DeBo RJ, Lees CJ, Dugan GO, Caudell DL, Michalson KT, Hanbury DB, Kavanagh K, Cline JM, Register TC. Late Effects of Total-Body Gamma Irradiation on Cardiac Structure and Function in Male Rhesus Macaques. Radiat Res 2016; 186:55-64. [PMID: 27333082 PMCID: PMC5068576 DOI: 10.1667/rr14357.1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart disease is an increasingly recognized, serious late effect of radiation exposure, most notably among breast cancer and Hodgkin's disease survivors, as well as the Hiroshima and Nagasaki atomic bomb survivors. The purpose of this study was to evaluate the late effects of total-body irradiation (TBI) on cardiac morphology, function and selected circulating biomarkers in a well-established nonhuman primate model. For this study we used male rhesus macaques that were exposed to a single total-body dose of ionizing gamma radiation (6.5-8.4 Gy) 5.6-9.7 years earlier at ages ranging from ∼3-10 years old and a cohort of nonirradiated controls. Transthoracic echocardiography was performed annually for 3 years on 20 irradiated and 11 control animals. Myocardium was examined grossly and histologically, and myocardial fibrosis/collagen was assessed microscopically and by morphometric analysis of Masson's trichrome-stained sections. Serum/plasma from 27 irradiated and 13 control animals was evaluated for circulating biomarkers of cardiac damage [N-terminal pro B-type natriuretic protein (nt-proBNP) and troponin-I], inflammation (CRP, IL-6, MCP-1, sICAM) and microbial translocation [LPS-binding protein (LBP) and sCD14]. A higher prevalence of histological myocardial fibrosis was observed in the hearts obtained from the irradiated animals (9/14) relative to controls (0/3) (P = 0.04, χ(2)). Echocardiographically determined left ventricular end diastolic and systolic diameters were significantly smaller in irradiated animals (repeated measures ANOVA, P < 0.001 and P < 0.008, respectively). Histomorphometric analysis of trichrome-stained sections of heart tissue demonstrated ∼14.9 ± 1.4% (mean ± SEM) of myocardial area staining for collagen in irradiated animals compared to 9.1 ± 0.9 % in control animals. Circulating levels of MCP-1 and LBP were significantly higher in irradiated animals (P < 0.05). A high incidence of diabetes in the irradiated animals was associated with higher plasma triglyceride and lower HDLc but did not appear to be associated with cardiovascular phenotypes. These results demonstrate that single total-body doses of 6.5-8.4 Gy produced long-term effects including a high incidence of myocardial fibrosis, reduced left ventricular diameter and elevated systemic inflammation. Additional prospective studies are required to define the time course and mechanisms underlying radiation-induced heart disease in this model.
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Affiliation(s)
| | - Cynthia J. Lees
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Greg O. Dugan
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David L. Caudell
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kris T. Michalson
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David B. Hanbury
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kylie Kavanagh
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - J. Mark Cline
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Thomas C. Register
- Department of Pathology/Comparative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Piroth MD, Petz D, Pinkawa M, Holy R, Eble MJ. Usefulness of a thermoplastic breast bra for breast cancer radiotherapy : A prospective analysis. Strahlenther Onkol 2016; 192:609-16. [PMID: 27287083 DOI: 10.1007/s00066-016-0981-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite modern techniques, in some patients receiving whole breast radiotherapy (WBI) parts of the heart and the lung might receive doses which are nowadays considered relevant for the development of late morbidity. Our aim was to analyze the usefulness of a thermoplastic breast brassiere to reduce lung and heart doses. PATIENTS AND METHODS A total of 29 patients with left-sided and 16 patients with right-sided breast cancer treated with breast conserving surgery and WBI between 2012 and 2013 were included in a prospective study analyzing the effectiveness of a thermoplastic breast bra. WBI was performed using 3D tangential fields up to 50.4 Gy. Treatment planning was performed with and without bra. Several dosimetrical parameters were analyzed comparatively focusing on the heart and ipsilateral lung. For heart dose comparisons, subvolumes like the left anterior descending artery (LAD) and a defined apical region, so-called "apical myocardial territory" (AMT), were defined. RESULTS By using the bra, the mean lung dose was reduced by 30.6 % (left-sided cancer) and 29.5 % (right-sided; p < 0.001). The V20Gy for the left lung was reduced by 39.5 % (4.9 vs. 8.1 % of volume; p < 0.001). The mean and maximum heart doses were significantly lower (1.6 vs. 2.1 Gy and 30.7 vs. 39.3 Gy; p = 0.01 and p < 0.001), which also applies to the mean and maximum dose for the AMT (2.5 vs. 4.4 Gy and 31.0 vs. 47.2 Gy; p < 0.01 and p < 0.001). The mean and maximum dose for LAD was lower without reaching significance. No acute skin toxicities > grade 2 were observed. CONCLUSION By using a thermoplastic breast bra, radiation doses to the heart and especially parts of the heart apex and ipsilateral lung can be significantly lowered without additional skin toxicity.
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Affiliation(s)
- Marc D Piroth
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany. .,Department of Radiation Oncology, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany.
| | - Dalma Petz
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Richard Holy
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Radiation Oncology, HELIOS University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany
| | - Michael J Eble
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
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Association between radiation dose to the heart and myocardial fatty acid metabolic impairment due to chemoradiation-therapy: Prospective study using I-123 BMIPP SPECT/CT. Radiother Oncol 2016; 119:77-83. [PMID: 26873792 DOI: 10.1016/j.radonc.2016.01.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate long term changes in myocardial fatty acid metabolic impairment caused by chemoradiation-therapy (CRT). MATERIALS AND METHODS We investigated 12 esophageal cancer patients who underwent SPECT/CT using I-123-labeled fatty acid analog (BMIPP) at pre-CRT, pre-boost irradiation, 3-month post-CRT, and 1-year post-CRT. The myocardial uptake was measured using the defect score and the total percentage of uptake (%uptake), which were defined as the sum of the visual scores and that of %uptake in each of 17 segments in the left ventricle (LV), respectively. The correlations between radiation dose to the heart (mean dose, V20, V40, and V60 of the LV and the whole heart (WH)) and the change of myocardial BMIPP uptake from pre-CRT (Δmyocardial BMIPP uptake) were assessed. RESULTS At pre-boost, Δmyocardial BMIPP uptake was significantly correlated with LV-V40 and WH-V60. At 3-month post-CRT, Δmyocardial BMIPP uptake was significantly correlated with LV-V40, WH-V40, and WH-V60. However, there were no statistically significant correlations at 1-year post-CRT. Neither mean dose nor V20 of the LV/WH was significantly correlated with Δmyocardial BMIPP uptake at any time. CONCLUSIONS In the long term after CRT, myocardial metabolism might be affected by factors other than the radiation dose to the heart.
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50
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Ming X, Feng Y, Liu H, Zhang Y, Zhou L, Deng J. Cardiac Exposure in the Dynamic Conformal Arc Therapy, Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy of Lung Cancer. PLoS One 2015; 10:e0144211. [PMID: 26630566 PMCID: PMC4667972 DOI: 10.1371/journal.pone.0144211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/13/2015] [Indexed: 02/05/2023] Open
Abstract
Purpose To retrospectively evaluate the cardiac exposure in three cohorts of lung cancer patients treated with dynamic conformal arc therapy (DCAT), intensity-modulated radiotherapy (IMRT), or volumetric modulated arc therapy (VMAT) at our institution in the past seven years. Methods and Materials A total of 140 lung cancer patients were included in this institutional review board approved study: 25 treated with DCAT, 70 with IMRT and 45 with VMAT. All plans were generated in a same commercial treatment planning system and have been clinically accepted and delivered. The dose distribution to the heart and the effects of tumor laterality, the irradiated heart volume and the beam-to-heart distance on the cardiac exposure were investigated. Results The mean dose to the heart among all 140 plans was 4.5 Gy. Specifically, the heart received on average 2.3, 5.2 and 4.6 Gy in the DCAT, IMRT and VMAT plans, respectively. The mean heart doses for the left and right lung tumors were 4.1 and 4.8 Gy, respectively. No patients died with evidence of cardiac disease. Three patients (2%) with preexisting cardiac condition developed cardiac disease after treatment. Furthermore, the cardiac exposure was found to increase linearly with the irradiated heart volume while decreasing exponentially with the beam-to-heart distance. Conclusions Compared to old technologies for lung cancer treatment, modern radiotherapy treatment modalities demonstrated better heart sparing. But the heart dose in lung cancer radiotherapy is still higher than that in the radiotherapy of breast cancer and Hodgkin’s disease where cardiac complications have been extensively studied. With strong correlations of mean heart dose with beam-to-heart distance and irradiated heart volume, cautions should be exercised to avoid long-term cardiac toxicity in the lung cancer patients undergoing radiotherapy.
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Affiliation(s)
- Xin Ming
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
| | - Yuanming Feng
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
| | - Huan Liu
- Department of Therapeutic Radiology, Yale-New Haven Hospital, New Haven, CT, United States of America
| | - Ying Zhang
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
| | - Li Zhou
- Center for Radiation Physics and Technology, West China Hospital Cancer Center, Sichuan University, Chengdu, China
| | - Jun Deng
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
- Department of Therapeutic Radiology, Yale-New Haven Hospital, New Haven, CT, United States of America
- * E-mail:
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