Malignancy and Radiation-Induced Cardiotoxicity

Mediastinal mass radiotherapy as adjuvant or primary treatment is usually performed for lung, breast and oesophagus cancer, for lymphoma and thymoma. However, untoward late cardiac and vascular adverse effects can develop that were underrecognized in the past because a very long latency from exposure to clinical manifestations is needed. Moreover, the true cumulative incidence of these complications is hard to correctly evaluate. Thoracic Radiotherapy (TR) may determine pathological involvement of pericardium, myocardium, cardiac valves, conduction system, coronary arteries and of subclavian and carotid arteries. The main clinical features of radiation induced cardiac and vascular diseases are discussed in the review. Recently, an increased risk of strokes and transient ischemic attacks (TIAs) has also been shown after TR, and the possible mechanisms as well as the measures useful in decreasing the risk are discussed. Other emerging aspects of radiation induced damages, just like malfunction of Pace Maker and of Implantable Defibrillators as well as malfunction of coronary bypass and coronary stents, probably will become more frequent in the next future. Finally, the current knowledge concerning the effects of the new modalities of administration of TR (doses, techniques) on the cardiovascular risk is reported, as well as the important clinical problem linked to the appropriate evaluation of the risk/benefit ratio of performing TR in different clinical situations.