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Is radiation-induced arteriopathy in long-term breast cancer survivors an underdiagnosed situation?: Critical and pragmatic review of available literature. Radiother Oncol 2021; 157:163-174. [PMID: 33515666 DOI: 10.1016/j.radonc.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/01/2021] [Accepted: 01/10/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Although considered exceptional, radiation-induced arteriopathy in long-term breast cancer survivors involves three main arterial domains in the irradiated volume, namely axillary-subclavian, coronary, and carotid. Stenosis of medium-large arteries is caused by "accelerated" atherosclerosis, particularly beyond 10 years after long-forgotten radiotherapy. The present review aims at summarizing what is known about arteriopathy, as well as the state of the art in terms of diagnosis and therapeutic management. DIAGNOSIS Pauci-symptomatic over years, the usual clinical presentation of arteriopathy involves arm pain with coldness due to subacute or critical ischemia (arterial occlusion), wrongly attributed to an exclusive neurological disorder, and more rarely transient ischemic accident or angina. Evaluation of the supra-aortic trunks by computed tomography and/or magnetic resonance angiography visualizes artery lesions, while Doppler ultrasonography in expert hands assesses diagnosis and downstream functional impact. In severe cases, more invasive angiography directly visualizes long irregular arterial stenosis (full-field radiotherapy), allowing accurate prognosis and treatment. MANAGEMENT Requires early diagnosis to enable initiation of medical treatment that increases blood flow (aspirin) as soon as moderate stenosis is detected, combined with correction of vascular risk factors. In intermediate cases, these therapeutic measures are completed by revascularization strategies using transluminal angioplasty-stenting (wall thickness). Antifibrotic treatment is useful in advanced cases with combined radiation injuries. CONCLUSION In follow-up of long-term breast cancer survivors with node irradiation, myocardial infarction is treated even if radiotherapy is forgotten, while recognition and diagnosis of chronic arm ischemia due to subclavian artery stenosis needs to be improved for appropriate therapeutic management.
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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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Messina F, Romano P, Paino M, Crosca S. Long-term complication of the thoracic radiation in breast cancer: An complete atrioventricular block case. Int J Cardiol 2016; 202:5-6. [PMID: 26368026 DOI: 10.1016/j.ijcard.2015.08.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Francesco Messina
- Diagnostic Radiology Unit, Hospital of Locri, Reggio Calabria, Italy
| | - Pietro Romano
- Diagnostic Radiology Unit, Hospital of Locri, Reggio Calabria, Italy
| | - Mario Paino
- Internal Medicine Unit, Hospital of Lipari, ASP 5 Messina, Italy
| | - Sergio Crosca
- Internal Medicine Unit, Hospital of Lipari, ASP 5 Messina, Italy.
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Caro-Codón J, Jiménez-Valero S, Galeote G, Sanchez-Recalde A, Moreno R. Radiation-induced coronary artery disease: Useful insights from OCT. Int J Cardiol 2015; 202:535-6. [PMID: 26451785 DOI: 10.1016/j.ijcard.2015.09.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/24/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Juan Caro-Codón
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain.
| | | | | | | | - Raul Moreno
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
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Cucunato M, Cannavà G, Currò A. Complete atrioventricular block can be a long-term complication of radiation therapy. Int J Cardiol 2015; 187:676-7. [PMID: 25880409 DOI: 10.1016/j.ijcard.2015.03.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 03/29/2015] [Accepted: 03/30/2015] [Indexed: 11/27/2022]
Affiliation(s)
- M Cucunato
- Endoscopy and Gastroenterology, Nursing home "Villa Salus", Messina, Italy
| | - G Cannavà
- Cardiac Intensive Care, Piemonte-Papardo Hospital, Messina, Italy
| | - Alessio Currò
- Cardiac Intensive Care, Piemonte-Papardo Hospital, Messina, Italy.
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Parato M, Pierri M, Torraca L, Scarano M. A giant myxoma of the left atrium involving the entirety of fossa ovalis: Clinical course, diagnosis and treatment. Int J Cardiol 2015; 186:35-6. [PMID: 25804463 DOI: 10.1016/j.ijcard.2015.03.216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Maurizio Parato
- Cardiology Unit, Emergency Dept, Hospital "Madonna del Soccorso", San Benedetto del Tronto, Italy
| | - Michele Pierri
- Cardiac Surgery Unit, Lancisi University Hospital, Ancona, Italy
| | - Lucia Torraca
- Cardiac Surgery Unit, Lancisi University Hospital, Ancona, Italy
| | - Michele Scarano
- Cardiac Surgery Unit, Lancisi University Hospital, Ancona, Italy.
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Imbalzano E, Lo Gullo A, Costantino R, Tomasello C, Giugno V, Saitta A. Coronary vasculitis in granulomatosis with polyangiitis. Int J Cardiol 2014; 173:593-5. [PMID: 24698240 DOI: 10.1016/j.ijcard.2014.03.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E Imbalzano
- Department of Internal Medicine, University of Messina, Italy.
| | - A Lo Gullo
- Department of Internal Medicine, University of Messina, Italy
| | - R Costantino
- Department of Internal Medicine, University of Messina, Italy
| | - C Tomasello
- Department of Internal Medicine, University of Messina, Italy
| | - V Giugno
- U.O. of Internal Medicine, Hospital of Locri, Italy
| | - A Saitta
- Department of Internal Medicine, University of Messina, Italy
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Santoro F, Tarantino N, Pellegrino PL, Caivano M, Lopizzo A, Di Biase M, Brunetti ND. Cardiovascular sequelae of radiation therapy. Clin Res Cardiol 2014; 103:955-67. [DOI: 10.1007/s00392-014-0718-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/15/2014] [Indexed: 01/13/2023]
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Transient ischemic attack due to an atrial septal defect. Int J Cardiol 2014; 173:e5-6. [DOI: 10.1016/j.ijcard.2014.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/09/2014] [Indexed: 11/20/2022]
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Giugno V, Crosca S. The occasional finding of a ventricular septal defect. Int J Cardiol 2014; 173:585-6. [DOI: 10.1016/j.ijcard.2014.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/14/2014] [Indexed: 11/16/2022]
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Trapani G, Quartuccio S, Dalbeni A, Stellitano A, Paunovic N, Imbalzano E. Late radiation-induced cardiac conduction system abnormalities. Int J Cardiol 2014; 173:e40-1. [DOI: 10.1016/j.ijcard.2014.03.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/14/2014] [Indexed: 11/28/2022]
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Scarano M, Pezzuoli F, Torrisi G, Calvagna G, Patanè S. Cardiovascular implantable electronic device infective endocarditis. Int J Cardiol 2014; 173:e38-9. [DOI: 10.1016/j.ijcard.2014.03.075] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 03/12/2014] [Indexed: 11/16/2022]
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Scarano M, Torrisi G, Calvagna GM, Patanè S. The occurrence of atrial fibrillation in Wolff–Parkinson–White syndrome. Int J Cardiol 2014; 173:e47-8. [DOI: 10.1016/j.ijcard.2014.03.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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Giugno V, Messina F, Crosca S. Treatment failure of low molecular weight heparin bridging therapy after implantation of a permanent pacemaker. Int J Cardiol 2014; 173:e23-4. [DOI: 10.1016/j.ijcard.2014.01.094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
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Radiotherapy and prevention of thrombosis in a patient with atrial fibrillation. Int J Cardiol 2014; 173:e18-9. [PMID: 24681012 DOI: 10.1016/j.ijcard.2014.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/09/2014] [Indexed: 11/20/2022]
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Scarano M, Parato VM, Labanti B, Imbalzano E. Stress status and ventricular fibrillation in long QT syndrome. Int J Cardiol 2014; 172:e438-40. [PMID: 24447737 DOI: 10.1016/j.ijcard.2013.12.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 12/30/2013] [Indexed: 12/23/2022]
Affiliation(s)
- M Scarano
- Cardiology Unit, Emergency Dept, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - V M Parato
- Cardiology Unit, Emergency Dept, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - B Labanti
- Cardiology Unit, Emergency Dept, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - E Imbalzano
- Departement of Internal Medicine, University of Messina, Italy.
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Scarano M, Pezzuoli F, Patanè S. Brucella infective endocarditis. Int J Cardiol 2014; 172:e509-10. [DOI: 10.1016/j.ijcard.2014.01.110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Renal denervation rapidly restores circulating proangiogenic hematopoietic cells in patients affected by drug-resistant hypertension. Int J Cardiol 2014; 173:591-2. [PMID: 24698255 DOI: 10.1016/j.ijcard.2014.03.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/14/2014] [Indexed: 01/19/2023]
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Radiation-induced heart and vessel atherosclerosis disease. Int J Cardiol 2014; 172:505-6. [DOI: 10.1016/j.ijcard.2014.01.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/10/2014] [Indexed: 11/20/2022]
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