Abstract
Background
Chest irradiation is a commonly used treatment for malignancy, with demonstrated symptomatic
and survival benefit. The frequency and presentation of cardiovascular complications
of radiotherapy remains unclear.
Methods
We performed a systematic review to evaluate the prevalence and manifestations of
myocardial dysfunction (asymptomatic and symptomatic) in long-term cancer survivors
treated with radiotherapy.
Results
Thoracic radiotherapy is associated with increased risk of heart failure in long-term
follow-up, with hazard ratios ranging from 2.7 to 7.4 for Hodgkin lymphoma, and 1.5-2.4
for breast cancer. Although ejection fraction is often normal, systolic dysfunction
has been more widely reported with modern techniques including 2-dimensional speckle
strain and cardiac magnetic resonance. This might have implications for the selection
of patients for cardioprotection. Despite common emphasis, diastolic functional abnormalities
were infrequent in the long term. A limited amount of data suggest that right ventricular
dysfunction is important in this population.
Conclusions
The reports were heterogeneous, used different treatments, end points, and definitions
of myocardial dysfunction, and most studies on the cardiac consequences of radiotherapy
involved small numbers of patients and were published decades ago, making it difficult
to formulate definitive conclusions for the current era.
Résumé
Introduction
La radiothérapie thoracique constitue un traitement courant contre le cancer qui a
montré des bienfaits tant du point de vue de la symptomatologie que de la survie des
patients. Le tableau et la fréquence des complications cardiovasculaires liées à ce
traitement demeurent toutefois peu connus.
Méthodes
Nous avons procédé à une revue systématique de la prévalence et des manifestations
de dysfonction myocardique (asymptomatique et symptomatique) chez des survivants à
long terme d’un cancer qui avaient subi une radiothérapie.
Résultats
La radiothérapie thoracique a été associée à une augmentation du risque d’insuffisance
cardiaque à long terme, le rapport des risques instantanés allant de 2,7 à 7,4 pour
le lymphome hodgkinien et de 1,5 à 2,4 pour le cancer du sein. Même si la fraction
d’éjection était souvent normale, une dysfonction systolique a fréquemment été diagnostiquée
grâce aux techniques modernes telles que l’échocardiographie bidimensionnelle des
marqueurs acoustiques (speckle-tracking) et l’imagerie par résonance magnétique cardiaque. Ceci pourrait avoir une incidence
sur le choix des patients nécessitant une cardioprotection. Même si elles sont souvent
mentionnées, les anomalies diastoliques fonctionnelles sont peu fréquentes à long
terme. Des données limitées indiquent aussi l’importance de la dysfonction ventriculaire
droite dans cette population.
Conclusions
Les données recueillies étaient hétérogènes en raison des différences entre les types
de traitements administrés, les paramètres d’évaluation fixés et les définitions de
la dysfonction myocardique utilisées. De plus, il a été difficile de tirer des conclusions
claires à partir de ces données puisque la plupart des études portant sur les effets
de la radiothérapie sur la fonction cardiaque ne comptaient qu’un petit nombre de
patients et ont été publiées il y a déjà plusieurs décennies.
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Article info
Publication history
Published online: December 28, 2015
Accepted:
December 7,
2015
Received:
October 27,
2015
Footnotes
See page 919 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
