Table 2.
Summary of publications focusing radiation-induced heart toxicity based on several findings, and deduced doses for heart and subvolumes
| Year of treatment | Method of detection | Time to effects | Heart or subvolume dose | Effect | |
|---|---|---|---|---|---|
| Darby et al. 2013 [29] | 1958–2001 | Retrospective population-based case–control study | Within 20 years/within first 4 years post RT |
Per 1 Gy mean heart dose Note: no significances for mean heart dose < 2 Gy |
Increase of relative risk for mayor coronary events: 7.4%/16.3% |
| van den Bogaard et al. 2017 [30] | 2005–2008 | – | Within 9 years post RT | Per 1 Gy mean heart dose | 16.5% increase in cumulative incidence (HR 1.165) for acute coronary events |
| van den Bogaard et al. 2017 [30] | 2005–2008 | – | Within 9 years post RT | V5LV: 29.3% vs. 16.9% | Acute coronary event vs. no |
| Carr et al. 2005 [32] | 1937–1965 | Retrospective analysis, estimating cardiac data | 22.5 years | Whole heart dose ≥ 2.8 (2.6–3) Gy and 5% volume of the heart (apex) ≥12.9 (12–13.9) Gy | Significant increase in coronary heart disease: relative risk 1.54; 95% CI: 1.15–2.06 |
| Marks et al. 2005 [24] | 1998–2001 | Cardiac SPECT imaging | 6–24 months | Cardiac apex included into the radiation fields (i. e., >23–25 Gy; 1.8–2 Gy per day) | 27–42% new perfusion defects in cardiac apex |
| <5% vs. ≥5% of the left LV into the radiation fields | Perfusion defects in 10–20% vs. 50–60% of patients | ||||
| Nilsson et al. 2012 [22] | 1970–2003 | Angiography | 10.3 years | Coronary arteries within (or near) the tangential radiation field, so called hotspot areas: mid, distal, and distal diagonal branch of LAD | Stenosis in LAD (mid, distal and distal diagonal branch of LAD) |
| Moignier et al. 2015 [23] | 2000–2008 | Coronary CT angiography | Median 6 years | Coronary artery segments: median 30.3 Gy vs. 26.3 Gy | Coronary stenosis |
| Skyttä et al. 2015 [28] | 2011–2013 | Serum troponin T | 9 months (mean) | Mean heart dose: 4 Gy vs. 2.8 Gy | Increase of serum troponin T (hscTNT) > 30% |
| Mean LV dose: 6.7 vs. 4.5 Gy | |||||
| Mean LAD dose: 23.8 vs. 17.5 Gy | |||||
| V20LAD: 55.4% vs. 36.2% | |||||
| V30LAD: 45% vs. 29.3% | |||||
| Erven et al. 2011 [25] | – | Regional strain value, detected by Doppler echocardiography | Immediately after RT and 2 months after RT | Left apical ventricular segments >3 Gy vs. <3 Gy | Significant decrease in strain respectively systolic myocardial function |
LV left ventricle; LAD left anterior descending artery; VxLV percent of left ventricle volume receiving ≥ x Gy, HR hazard ratio, SPECT single-photon emission computed tomography, hscTNT high-sensitivity cardiac troponin T, RT radiotherapy