The impact of proton therapy on cardiotoxicity following radiation treatment
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The impact of proton therapy on cardiotoxicity following radiation treatment Andrew J. Frankart1 · Rajaram Nagarajan2,3 · Luke Pater1 Accepted: 30 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Cardiac disease following radiation therapy represents a major consideration in the treatment of a variety of malignancies. Damage to the heart can manifest in a variety of pathologies including ischemic cardiac disease, cardiomyopathy, valvular dysfunction, arrhythmias, and pericarditis. This damage has been shown to directly relate to cardiac radiation dose and to stem from a range of cellular pathways that are often related to fibrosis. The importance of minimizing radiation dose to the heart is especially critical in the pediatric population and when treating disease sites adjacent to the heart. Proton therapy represents a promising approach to minimize dose to normal tissues such as the heart. The cardiac dosimetry reductions due to proton therapy have been demonstrated in multiple cancers and further long-term follow-up will determine the clinical significance of these reductions to cardiac structures. Future approaches using advanced techniques such as FLASH therapy could provide even further benefit by reducing post-radiation fibrosis. Keywords Cardiotoxicity · Radiation · Proton therapy · Dosimetry · Pediatric cancer
Highlights • There are established correlations between the radiation
dose to the heart and the risk of subsequent cardiac disease. • Proton therapy represents a contemporary treatment approach that can result in a decreased radiation dose to cardiac structures. • Further research is warranted to explore novel radiation techniques to minimize cardiac exposure to radiation.
* Andrew J. Frankart [email protected] 1
Department of Radiation Oncology, University of Cincinnati, 234 Goodman Street, ML 0757, Cincinnati, OH 45267, USA
2
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
3
Division of Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Introduction Radiation therapy is utilized as a definitive and adjuvant treatment for a number of malignancies. As with all oncologic care, the delivery of radiation must strike a balance between maximizing disease control and minimizing toxicity to achieve an optimal therapeutic ratio. This is particularly true in the pediatric setting as survival continues to improve with advances in surgical, radiation, and systemic therapy approaches to treatment, resulting in longer life expectancies and a shift to focusing on post-treatment health and quality of life [1]. Cardiac exposure from radiotherapy may lead to worsening cardiac function through a number of pathways including coronary artery disease, cardiomyopathies, pericardial damage, arrhythmias, and valvular disease [2]. This article aims to summarize the contemporary understanding of radiation-induced cardiac toxicity and the impact of approaches to minimize this outcome.
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