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Published in: Current Cardiology Reports 10/2023

16-08-2023 | Pericardial Disease | Pericardial Disease (AL Klein and CL Jellis, Section Editors)

Radiation-Induced Pericardial Disease: Mechanisms, Diagnosis, and Treatment

Authors: Berlinde A. von Kemp, Bernard Cosyns

Published in: Current Cardiology Reports | Issue 10/2023

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Abstract

Purpose of Review

We aim to give a concise overview of the different clinical manifestations of both acute and long-term radiotherapy-related pericardial diseases, the underlying pathophysiology as well as the diagnosis and treatment options.

Recent Findings

Radiotherapy-related pericardial disease is common, but despite radiotherapy being a cornerstone of many cancer treatments, this disease entity is relatively underrepresented in clinical trials, resulting in a paucity of research data on pathophysiology and management.

Summary

Since the development of innovative cancer treatments, survival has significantly improved. Therefore, the importance of long-term treatment-related side effects increases, most notably cancer treatment-related cardiovascular toxicity. In patients undergoing radiotherapy as a part of their cancer treatment, radiotherapy-related pericardial disease can manifest early (during or shortly after radiotherapy administration) or very late (several years to decades after treatment). This exceptionally long latency period confronts physicians with treatment-related side effects of radiotherapy regimens that may have been abandoned already.
Literature
1.
go back to reference Sung H, Ferlay J, Siegel RL, Laversanne L, Soerjomataram I, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.CrossRefPubMed Sung H, Ferlay J, Siegel RL, Laversanne L, Soerjomataram I, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.CrossRefPubMed
2.
go back to reference Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014;89:1287–306.CrossRefPubMed Herrmann J, Lerman A, Sandhu NP, Villarraga HR, Mulvagh SL, Kohli M. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014;89:1287–306.CrossRefPubMed
3.
go back to reference • Mitchell JD, Cehic DA, Morgia M, Bergom C, Toohey J, et al. Cardiovascular manifestations from therapeutic radiation : a multidisciplinary consensus statement from the International Cardio-Oncology Society. J Am Coll Cardiol CardioOnc. 2021;3:360–80. This paper summarizes current recommendations in the management of radiotherapy-related cardiovascular disease. • Mitchell JD, Cehic DA, Morgia M, Bergom C, Toohey J, et al. Cardiovascular manifestations from therapeutic radiation : a multidisciplinary consensus statement from the International Cardio-Oncology Society. J Am Coll Cardiol CardioOnc. 2021;3:360–80. This paper summarizes current recommendations in the management of radiotherapy-related cardiovascular disease.
4.
go back to reference Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005;104:1129–37.CrossRefPubMed Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005;104:1129–37.CrossRefPubMed
5.
go back to reference • Quintero-Martinez JA, Cordova-Madera SN, Villarraga HR. Radiation-induced heart disease. J. Clin Med. 2022;11:146. This review provides an in-depth overview of the basis of RT-induced cardiovascular complications. • Quintero-Martinez JA, Cordova-Madera SN, Villarraga HR. Radiation-induced heart disease. J. Clin Med. 2022;11:146. This review provides an in-depth overview of the basis of RT-induced cardiovascular complications.
6.
go back to reference •• Lyon AR, López-Fernández T, Couch LS, Asteggiano A, Aznar MC et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO), and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;00:1–133. •• Lyon AR, López-Fernández T, Couch LS, Asteggiano A, Aznar MC et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO), and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;00:1–133.
7.
go back to reference Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. New Engl J Med. 2013;368:987–98.CrossRefPubMed Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. New Engl J Med. 2013;368:987–98.CrossRefPubMed
8.
go back to reference •• Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International CardiO-Oncology Society. Eur J Heart Fail 2020;22:1945–60. Position statement for baseline cardiotoxicity risk stratification in patients undergoing potentially cardiotoxic treatments, highlighting the predisposing role of RT for developing cardiotoxicity in complex combination treatments. •• Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International CardiO-Oncology Society. Eur J Heart Fail 2020;22:1945–60. Position statement for baseline cardiotoxicity risk stratification in patients undergoing potentially cardiotoxic treatments, highlighting the predisposing role of RT for developing cardiotoxicity in complex combination treatments.
9.
go back to reference Desai MY, Jellis CL, Kotecha R, Johnston DR, Griffin BP. Radiation-associated cardiac disease : a practical approach to diagnosis and management. J Am Coll Cardiol Img. 2018;11:1132–49.CrossRef Desai MY, Jellis CL, Kotecha R, Johnston DR, Griffin BP. Radiation-associated cardiac disease : a practical approach to diagnosis and management. J Am Coll Cardiol Img. 2018;11:1132–49.CrossRef
10.
11.
go back to reference •• Gevaert SA, Halvorsen S, Sinnaeve PR, Sambola A, Gulati G et al. Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Consensus Document of the Acute CardioVascular Care (ACVC) association and the ESC council of cardio-oncology - part 1: acute coronary syndromes and acute pericardial diseases. Eur Heart J Acute Cardiovasc Care. 2021;10:947–59. Focused paper on pericardial disease in cancer patients, highlighting the importance of differential diagnosis and treatment options. •• Gevaert SA, Halvorsen S, Sinnaeve PR, Sambola A, Gulati G et al. Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Consensus Document of the Acute CardioVascular Care (ACVC) association and the ESC council of cardio-oncology - part 1: acute coronary syndromes and acute pericardial diseases. Eur Heart J Acute Cardiovasc Care. 2021;10:947–59. Focused paper on pericardial disease in cancer patients, highlighting the importance of differential diagnosis and treatment options.
12.
go back to reference Ala CK, Klein AL, Moslehi JJ. Cancer treatment-associated pericardial disease: epidemiology, clinical presentation, diagnosis and management. Curr Cardiol Rep. 2019;21:156.CrossRefPubMed Ala CK, Klein AL, Moslehi JJ. Cancer treatment-associated pericardial disease: epidemiology, clinical presentation, diagnosis and management. Curr Cardiol Rep. 2019;21:156.CrossRefPubMed
14.
go back to reference Adler Y, Charron P, Imazio M, Badano L, Baron-Esquivias G, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2022;36:2921–64.CrossRef Adler Y, Charron P, Imazio M, Badano L, Baron-Esquivias G, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2022;36:2921–64.CrossRef
15.
go back to reference Chahine J, Shekhar S, Mahalwar G, Imazio M, Collier P, Klein A. Pericardial involvement in cancer. Am J Cardiol. 2021;145:151–9.CrossRefPubMed Chahine J, Shekhar S, Mahalwar G, Imazio M, Collier P, Klein A. Pericardial involvement in cancer. Am J Cardiol. 2021;145:151–9.CrossRefPubMed
16.
go back to reference •• Podlesnikar T, Berlot B; Dolenc J, Goricar K, Marinko T. Radiotherapy-induced cardiotoxicity : the role of multimodality cardiovascular imaging. Front Cardiovasc Med. 2022;9:887705. Comprehensive overview detailing the additional value of different imaging modalities in the diagnosis of RT-induced cardiovascular disease. •• Podlesnikar T, Berlot B; Dolenc J, Goricar K, Marinko T. Radiotherapy-induced cardiotoxicity : the role of multimodality cardiovascular imaging. Front Cardiovasc Med. 2022;9:887705. Comprehensive overview detailing the additional value of different imaging modalities in the diagnosis of RT-induced cardiovascular disease.
17.
go back to reference Burazor I, Imazio M, Markel G, Adler Y. Malignant pericardial effusion. Cardiology. 2013;124:224–32.CrossRefPubMed Burazor I, Imazio M, Markel G, Adler Y. Malignant pericardial effusion. Cardiology. 2013;124:224–32.CrossRefPubMed
18.
go back to reference Ghosh AK, Crake T, Manisty C, Westwood M. Pericardial disease in cancer patients. Curr Treat Options Cardio Med. 2018;20:60.CrossRef Ghosh AK, Crake T, Manisty C, Westwood M. Pericardial disease in cancer patients. Curr Treat Options Cardio Med. 2018;20:60.CrossRef
19.
go back to reference Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, et al. Expert consensus for multi-modality imaging evalution of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26:1013–32.CrossRefPubMed Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, et al. Expert consensus for multi-modality imaging evalution of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26:1013–32.CrossRefPubMed
20.
go back to reference Imazio M, Colopi M, De Ferrari GM. Pericardial diseases in patients with cancer: contemporary prevalence, management and outcomes. Heart. 2020;106:569–74.CrossRefPubMed Imazio M, Colopi M, De Ferrari GM. Pericardial diseases in patients with cancer: contemporary prevalence, management and outcomes. Heart. 2020;106:569–74.CrossRefPubMed
21.
go back to reference Drost L, Yee C, Lam H, Zhang L, Wronski M, et al. A systematic review of heart dose in breast radiotherapy. Clin Breast Cancer. 2018;18:e819–24.CrossRefPubMed Drost L, Yee C, Lam H, Zhang L, Wronski M, et al. A systematic review of heart dose in breast radiotherapy. Clin Breast Cancer. 2018;18:e819–24.CrossRefPubMed
22.
go back to reference Veinot JP, Edwards WD. Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol. 1996;27:766–73.CrossRefPubMed Veinot JP, Edwards WD. Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol. 1996;27:766–73.CrossRefPubMed
23.
go back to reference Frankart AJ, Nagarajan R, Pater L. The impact of proton therapy on cardiotoxicity following radiation treatment. J Thromb Thrombolysis. 2021;51:877–83.CrossRefPubMed Frankart AJ, Nagarajan R, Pater L. The impact of proton therapy on cardiotoxicity following radiation treatment. J Thromb Thrombolysis. 2021;51:877–83.CrossRefPubMed
24.
go back to reference • Bergom C, Bradley JA, Ng AK, Samson P, Robinson C, Lopez-Mattei J, Mitchell JD. Past, present and future of radiation-induced cardiotoxicity: refinements in targeting, surveillance, and risk stratification. J Am Coll Cardiol CardioOnc. 2021;3:343–59. Comprehensive overview of current data in RT-induced cardiovascular disease, focusing on optimization of RT delivery modalities. • Bergom C, Bradley JA, Ng AK, Samson P, Robinson C, Lopez-Mattei J, Mitchell JD. Past, present and future of radiation-induced cardiotoxicity: refinements in targeting, surveillance, and risk stratification. J Am Coll Cardiol CardioOnc. 2021;3:343–59. Comprehensive overview of current data in RT-induced cardiovascular disease, focusing on optimization of RT delivery modalities.
25.
go back to reference McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, et al. Incidence of heart disease in 35.000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol. 2011;100:167–75. McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, et al. Incidence of heart disease in 35.000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol. 2011;100:167–75.
26.
go back to reference Marinko T. Pericardial disease after breast cancer radiotherapy. Radiol Oncol. 2019;53:1–5.CrossRef Marinko T. Pericardial disease after breast cancer radiotherapy. Radiol Oncol. 2019;53:1–5.CrossRef
27.
go back to reference Andratschke N, Maurer J, Molls M, Trott KR. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention. Radiother Oncol. 2011;100:160–6. Andratschke N, Maurer J, Molls M, Trott KR. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention. Radiother Oncol. 2011;100:160–6.
28.
go back to reference Garcia MJ. Constrictive pericarditis versus restrictive cardiomyopathy? J Am coll Cardiol. 2016;67:2061–76.CrossRefPubMed Garcia MJ. Constrictive pericarditis versus restrictive cardiomyopathy? J Am coll Cardiol. 2016;67:2061–76.CrossRefPubMed
29.
go back to reference Palaskas N, Morgan J, Daigle T, Banchs J, Durand JB, et al. Targeted cancer therapies with pericardial effusions requiring pericardiocentesis focusing on immune checkpoint inhibitors. Am J Cardiol. 2019;123:1351–7.CrossRefPubMed Palaskas N, Morgan J, Daigle T, Banchs J, Durand JB, et al. Targeted cancer therapies with pericardial effusions requiring pericardiocentesis focusing on immune checkpoint inhibitors. Am J Cardiol. 2019;123:1351–7.CrossRefPubMed
30.
go back to reference Strobbe A, Adriaenssens T, Bennett J, Dubois C, Desmet W, et al. Etiology and long-term outcome of patients undergoing pericardiocentesis. J Am Heart Assoc. 2017;6: e007598.CrossRefPubMedPubMedCentral Strobbe A, Adriaenssens T, Bennett J, Dubois C, Desmet W, et al. Etiology and long-term outcome of patients undergoing pericardiocentesis. J Am Heart Assoc. 2017;6: e007598.CrossRefPubMedPubMedCentral
31.
go back to reference Patel N, Rafique AM, Eshaghian S, Mendoza F, et al. Retrospective comparison of outcomes, diagnostic value, and complications of percutaneous prolonged drainage versus surgical pericardiotomy of pericardial effusion associated with malignancy. Am J Cardiol. 2013;112:1235–9.CrossRefPubMed Patel N, Rafique AM, Eshaghian S, Mendoza F, et al. Retrospective comparison of outcomes, diagnostic value, and complications of percutaneous prolonged drainage versus surgical pericardiotomy of pericardial effusion associated with malignancy. Am J Cardiol. 2013;112:1235–9.CrossRefPubMed
32.
go back to reference Irazusta FJ, Jimenez-Valero S, Gemma D, Meras P, Galeote G, et al. Percutaneous balloon pericardiotomy: treatment of choice in patients with advanced oncological disease and severe pericardial effusion. Cardiovasc Revasc Med. 2017;18:S14–7.CrossRefPubMed Irazusta FJ, Jimenez-Valero S, Gemma D, Meras P, Galeote G, et al. Percutaneous balloon pericardiotomy: treatment of choice in patients with advanced oncological disease and severe pericardial effusion. Cardiovasc Revasc Med. 2017;18:S14–7.CrossRefPubMed
33.
go back to reference George TJ, Arnaoutakis GJ, Beaty CA, Kilic A, Baumgartner WA, et al. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann Thorac Surg. 2012;94:445–51.CrossRefPubMedPubMedCentral George TJ, Arnaoutakis GJ, Beaty CA, Kilic A, Baumgartner WA, et al. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann Thorac Surg. 2012;94:445–51.CrossRefPubMedPubMedCentral
34.
go back to reference Sogaard KK, Farkas DK, Ehrenstein V, Bhaskaran K, Botker HE, Sorensen HT. Pericarditis as a marker of occult cancer and a prognostic factor for cancer mortality. Circulation. 2017;11:996–1006.CrossRef Sogaard KK, Farkas DK, Ehrenstein V, Bhaskaran K, Botker HE, Sorensen HT. Pericarditis as a marker of occult cancer and a prognostic factor for cancer mortality. Circulation. 2017;11:996–1006.CrossRef
Metadata
Title
Radiation-Induced Pericardial Disease: Mechanisms, Diagnosis, and Treatment
Authors
Berlinde A. von Kemp
Bernard Cosyns
Publication date
16-08-2023
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 10/2023
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-023-01933-3

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