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Advancements in Radiation Therapy: Minimizing Cardiac Risks and Improving Cancer Treatment Outcomes

Jing Li

Over the past two decades, there has been a noticeable increase in cancer incidence and survivorship, mainly attributed to advancements in treatment modalities. One significant approach is radiation therapy (RT), utilized in 20-55% of cancer patients. Its fundamental principle involves either inhibiting the growth of cancer cells or inducing apoptosis. Historically, photon beam RT has been the primary choice for treatment. However, in recent years, proton beam therapy has emerged as a new option. This innovative method focuses more precisely on the tumor, minimizing damage to surrounding healthy tissues, such as the heart. Unfortunately, radiation to the heart remains a common complication of RT, particularly in patients with lymphoma, breast, lung, and esophageal cancer. The underlying cause lies in changes to the microvascular and macrovascular environment, which can lead to accelerated atherosclerosis and fibrosis of the heart’s myocardium, pericardium, and valves. These complications may manifest days, weeks, or even years after RT, and several risk factors contribute to their occurrence. These factors include high radiation doses (>30 Gy), concurrent chemotherapy (especially anthracyclines), advanced age, pre-existing heart disease, and the presence of other cardiovascular risk factors. For physicians, understanding these mechanisms and risk factors is crucial, as it enables them to assess and monitor patients more effectively, with the goal of early detection and prevention of radiation-induced heart disease. Echocardiography, a noninvasive method that comprehensively evaluates the pericardium, heart valves, myocardium, and coronary arteries, is often the initial imaging tool used. Nevertheless, additional modalities like computed tomography, nuclear medicine, or cardiac magnetic resonance can provide valuable supplementary information. By employing a tailored approach to patient assessment and monitoring, healthcare professionals can mitigate the risks associated with radiation-induced heart disease, enhancing the overall care and well-being of cancer survivors.