Current Cardioprotective Strategies for the Prevention of Radiation-Induced Cardiotoxicity in Left-Sided Breast Cancer Patients

Author:

Nikovia Vasiliki1,Chinis Evangelos1,Gkantaifi Areti2ORCID,Marketou Maria3ORCID,Mazonakis Michalis4,Charalampakis Nikolaos5ORCID,Mavroudis Dimitrios6,Orfanidou Kornilia Vasiliki1,Varveris Antonios7,Antoniadis Chrysostomos7,Tolia Maria7ORCID

Affiliation:

1. Medical School, University of Crete, Vassilika, 71110 Heraklion, Greece

2. Radiotherapy Department, Theagenio Anticancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece

3. Cardiology Department, University General Hospital of Heraklion, Heraklion, 71110 Heraklion, Greece

4. Department of Medical Physics, Faculty of Medicine, University of Cret, Iraklion, P.O. Box 2208, 71003 Heraklion, Greece

5. Oncology Clinic, Metaxa Cancer Hospital, Mpotasi 51, 18537 Piraeus, Greece

6. Department of Medical Oncology, University General Hospital of Heraklion, 71500 Heraklion, Greece

7. Department of Radiotherapy, University Hospital/Medical School, University of Crete, Vassilika, 71110 Heraklion, Greece

Abstract

Background: Breast cancer (BC) is the most common malignancy in females, accounting for the majority of cancer-related deaths worldwide. There is well-established understanding about the effective role of radiotherapy (RT) in BC therapeutic strategies, offering a better local–regional control, prolonged survival, and improved quality of life for patients. However, it has been proven that conventional RT modalities, especially in left-sided BC cases, are unable to avoid the administration of high RT doses to the heart, thus resulting in cardiotoxicity and promoting long-term cardiovascular diseases (CVD). Recent radiotherapeutic techniques, characterized by dosimetric dose restrictions, target volume revision/modifications, an increased awareness of risk factors, and consistent follow-ups, have created an advantageous context for a significant decrease inpost-RT CVD incidence. Aim: This review presents the fundamental role of current cardioprotective strategies in the prevention of cardiotoxic effects in left-BCRT. Material and Methods: A literature search was conducted up to January 2023 using the Cochrane Central Register of Controlled Trials and PubMed Central databases. Our review refers to new radiotherapeutic techniques carried out on patients after BC surgery. Specifically, a dose evaluation of the heart and left anterior descending coronary artery (LADCA) was pointed out for all the included studies, depending on the implemented RT modality, bed positioning, and internal mammary lymph nodes radiation. Results: Several studies reporting improved heart sparing with new RT techniques in BC patients were searched. In addition to the RT modality, which definitely determines the feasibility of achieving lower doses for the organs at risk (OARs), better target coverage, dose conformity and homogeneity, and the patient’s position, characteristics, and anatomy may also affect the evaluated RT dose to the whole heart and its substructures. Conclusions: Modern BC RT techniques seem to enable the administration of lower doses to the OARs without compromising on the target coverage. The analysis of several anatomical parameters and the assessment of cardiac biomarkers potentiate the protective effect of these new irradiation modalities, providing a holistic approach to the radiation-associated risks of cardiac disease for BC patients. Despite technological advances, an inevitable cardiac radiation risk still exists, while adverse cardiac events may be observed even many years after RT. Studies with longer follow-ups are required in order to determine the effectiveness of modern breast RT techniques.

Publisher

MDPI AG

Subject

Medicine (miscellaneous)

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