Efeitos tardios da radioterapia mediastinal sobre as valvas cardíacas:
uma revisão narrativa
DOI:
https://doi.org/10.37951/2358-9868.2022v10i2.p95-102Palavras-chave:
radioterapia mediastinal, irradiação mediastinal, cardiopatia induzida por radiação, doença valvar cardíaca induzida por radiação, radioterapia, doença valvar cardíaca, câncerResumo
A utilização da radioterapia (RT) mediastinal para tratar tumores próximos ao coração pode resultar em doença valvar cardíaca induzida pela radiação, dentre outras patologias cardiovasculares. Pode haver um intervalo de latência de anos ou décadas entre a exposição à radiação e o desenvolvimento de doença valvar cardíaca clinicamente significativa, com o dano valvar caracterizado por fibrose e calcificação. O aumento de risco está relacionado à dose de radiação recebida, ao intervalo desde a última exposição e ao uso concomitante de quimioterapia cardiotóxica. Desfechos clínicos relevantes a longo prazo e o risco perioperatório de cirurgia valvar estão relacionados aos efeitos da radiação nas estruturas mediastinais, incluindo fibrose pulmonar, disfunção ventricular e constrição pericárdica. Novas técnicas de RT mediastinal estão sendo desenvolvidas para reduzir a dose de radiação no coração. Estratégias de vigilância e rastreamento são requeridas para este grupo de sobreviventes de câncer sob risco de desenvolver complicações valvares significativas.
Referências
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2- Cohn KE, Stewart JR, Pajardo LF, Hancock EW. Heart disease following radiation. Med (Baltimore). 1967; 46(3):281-98;
3- Gottdiener JS, Katin MJ, Borer JS, et al. Late cardiac effects of therapeutic mediastinal irradiation: assessment by echocardiography and radionuclide angiography. N Engl J Med. 1983; 308:569-72;
4- Wethal T, Lund MB, Edvardsen T, et al. Valvular dysfunction and left ventricular changes in Hodgkin’s lymphoma survivors. A longitudinal study. Br J Cancer. 2009; 101:575-81;
5- Glanzmann C, Kaufmann P, Jenni R, et al. Cardiac risk after mediastinal irradiation for Hodgkin’s disease. Radiother Oncol. 1998; 46(1):51-62;
6- Bijl JM, Roos MM, Van Leeuwen-Segarceanu EM, et al. Assessment of valvular disorders in survivors of Hodgkin’s lymphoma treated by mediastinal radiotherapy ± chemotherapy. Am J Cardiol. 2016; 117(4):691-6;
7- Jaworski C, Mariani JA, Wheeler G, Kaye DM. Cardiac complications of thoracic irradiation. J Am Coll Cardiol. 2013; 61(23):2319-28;
8- Cutter DJ, Schaapveld M, Darby SC, et al. Risk of valvular heart disease after treatment for Hodgkin lymphoma. J Natl Cancer Inst. 2015; 107:djv008;
9- Hull MC, Morris CG, Pepine CJ, et al. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA. 2003; 290:2831-7;
10- Aleman BM, van den Belt-Dusevout AW, De Bruin ML, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007; 109: 1878-86;
11- Veinot JP, Edwards WD. Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol. 1996; 27:766-73;
12- Brosius FC III, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3.500 rads to the heart. Am J Med. 1981; 70:519-30;
13- Yamold J, Brotons MC. Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol. 2010. 97:149-61;
14- Nadlonek NA, Weyant MJ, Yu JA, et al. Radiation induces osteogenesis in human aortic valve interstitial cells. J Thorac Cardiovasc Surg. 2012; 144:1466-70;
15- Perrault DJ, Levy M, Herman JD, et al. Echocardiographic abnormalities following cardiac radiation. J Clin Oncol. 1985; 3:546-51;
16- Lancellotti P, Nkomo VT, Badano LP, et al. Expert consensus for multi-modality imaging evaluation 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(9):1013-32;
17- Kamdar AR, Meadows TA, Roselli EE, et al. Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery. Ann Thorac Surg. 2008; 85(4):1239-45;
18- Desai MY, Windecker S, Lancellotti P, et al. Prevention, Diagnosis and Management of Radiation-Associated Cardiac Disease: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019; 74(7):905-27;
19- Handa N, McGregor CG, Danielson GK, et al. Valvular heart operation in patients with previous mediastinal radiation therapy. Ann Thorac Surg. 2001; 71:1880-4;
20- Chang AS, Smedira NG, Chang CL, et al. Cardiac surgery after mediastinal radiation: extent of exposure influences outcome. J Thorac Cardiovasc Surg. 2007; 133:404-13;
21- Abramowitz Y, Jilaihawi H, Chakravarty T, et al. Porcelain aorta: a comprehensive review. Circulation. 2015; 131:827-36;
22- Wu W, Masri A, Popovic ZB, et al. Long-term survival of patients with radiation heart disease undergoing cardiac surgery: a cohort study. Circulation. 2013; 127:1476-85;
23- Dijos M, Reynaud A, Leroux L, et al. Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis. Open Heart. 2015; 2:e000252
24- Franzen O, Baldus S, Rudolph V, et al. Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis of adverse valve morphology and severe left ventricular dysfunction. Eur Heart J. 2010; 31:1373-81;
25- Maraldo MV, Brodin NP, Vogelius IR, et al. Risk of developing cardiovascular disease after involved node radiotherapy versus mantle field for Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2012; 83:1232-7;
26- Hoppe BS, Flampouri S, Su Z, et al. Effective dose reduction to cardiac structures using prótons compared with 3DCRT and IMRT in mediastinal Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2012; 84:449-55;
27- Gujral DM, Lloyd G, Bhattacharyya S. Radiation-induced valvular heart disease. Heart. 2016; 102(4):269-76.
2- Cohn KE, Stewart JR, Pajardo LF, Hancock EW. Heart disease following radiation. Med (Baltimore). 1967; 46(3):281-98;
3- Gottdiener JS, Katin MJ, Borer JS, et al. Late cardiac effects of therapeutic mediastinal irradiation: assessment by echocardiography and radionuclide angiography. N Engl J Med. 1983; 308:569-72;
4- Wethal T, Lund MB, Edvardsen T, et al. Valvular dysfunction and left ventricular changes in Hodgkin’s lymphoma survivors. A longitudinal study. Br J Cancer. 2009; 101:575-81;
5- Glanzmann C, Kaufmann P, Jenni R, et al. Cardiac risk after mediastinal irradiation for Hodgkin’s disease. Radiother Oncol. 1998; 46(1):51-62;
6- Bijl JM, Roos MM, Van Leeuwen-Segarceanu EM, et al. Assessment of valvular disorders in survivors of Hodgkin’s lymphoma treated by mediastinal radiotherapy ± chemotherapy. Am J Cardiol. 2016; 117(4):691-6;
7- Jaworski C, Mariani JA, Wheeler G, Kaye DM. Cardiac complications of thoracic irradiation. J Am Coll Cardiol. 2013; 61(23):2319-28;
8- Cutter DJ, Schaapveld M, Darby SC, et al. Risk of valvular heart disease after treatment for Hodgkin lymphoma. J Natl Cancer Inst. 2015; 107:djv008;
9- Hull MC, Morris CG, Pepine CJ, et al. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA. 2003; 290:2831-7;
10- Aleman BM, van den Belt-Dusevout AW, De Bruin ML, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007; 109: 1878-86;
11- Veinot JP, Edwards WD. Pathology of radiation-induced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol. 1996; 27:766-73;
12- Brosius FC III, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3.500 rads to the heart. Am J Med. 1981; 70:519-30;
13- Yamold J, Brotons MC. Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol. 2010. 97:149-61;
14- Nadlonek NA, Weyant MJ, Yu JA, et al. Radiation induces osteogenesis in human aortic valve interstitial cells. J Thorac Cardiovasc Surg. 2012; 144:1466-70;
15- Perrault DJ, Levy M, Herman JD, et al. Echocardiographic abnormalities following cardiac radiation. J Clin Oncol. 1985; 3:546-51;
16- Lancellotti P, Nkomo VT, Badano LP, et al. Expert consensus for multi-modality imaging evaluation 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(9):1013-32;
17- Kamdar AR, Meadows TA, Roselli EE, et al. Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery. Ann Thorac Surg. 2008; 85(4):1239-45;
18- Desai MY, Windecker S, Lancellotti P, et al. Prevention, Diagnosis and Management of Radiation-Associated Cardiac Disease: JACC Scientific Expert Panel. J Am Coll Cardiol. 2019; 74(7):905-27;
19- Handa N, McGregor CG, Danielson GK, et al. Valvular heart operation in patients with previous mediastinal radiation therapy. Ann Thorac Surg. 2001; 71:1880-4;
20- Chang AS, Smedira NG, Chang CL, et al. Cardiac surgery after mediastinal radiation: extent of exposure influences outcome. J Thorac Cardiovasc Surg. 2007; 133:404-13;
21- Abramowitz Y, Jilaihawi H, Chakravarty T, et al. Porcelain aorta: a comprehensive review. Circulation. 2015; 131:827-36;
22- Wu W, Masri A, Popovic ZB, et al. Long-term survival of patients with radiation heart disease undergoing cardiac surgery: a cohort study. Circulation. 2013; 127:1476-85;
23- Dijos M, Reynaud A, Leroux L, et al. Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis. Open Heart. 2015; 2:e000252
24- Franzen O, Baldus S, Rudolph V, et al. Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis of adverse valve morphology and severe left ventricular dysfunction. Eur Heart J. 2010; 31:1373-81;
25- Maraldo MV, Brodin NP, Vogelius IR, et al. Risk of developing cardiovascular disease after involved node radiotherapy versus mantle field for Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2012; 83:1232-7;
26- Hoppe BS, Flampouri S, Su Z, et al. Effective dose reduction to cardiac structures using prótons compared with 3DCRT and IMRT in mediastinal Hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2012; 84:449-55;
27- Gujral DM, Lloyd G, Bhattacharyya S. Radiation-induced valvular heart disease. Heart. 2016; 102(4):269-76.
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2022-12-20
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