Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care
Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fcvm.2020.00016/full |
| _version_ | 1819212908741001216 |
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| author | Moon-Sing Lee Moon-Sing Lee Dai-Wei Liu Dai-Wei Liu Shih-Kai Hung Shih-Kai Hung Shih-Kai Hung Chih-Chia Yu Chih-Chia Yu Chen-Lin Chi Chen-Lin Chi Wen-Yen Chiou Wen-Yen Chiou Wen-Yen Chiou Liang-Cheng Chen Liang-Cheng Chen Liang-Cheng Chen Ru-Inn Lin Ru-Inn Lin Li-Wen Huang Li-Wen Huang Li-Wen Huang Chia-Hui Chew Chia-Hui Chew Chia-Hui Chew Feng-Chun Hsu Michael W. Y. Chan Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin |
| author_facet | Moon-Sing Lee Moon-Sing Lee Dai-Wei Liu Dai-Wei Liu Shih-Kai Hung Shih-Kai Hung Shih-Kai Hung Chih-Chia Yu Chih-Chia Yu Chen-Lin Chi Chen-Lin Chi Wen-Yen Chiou Wen-Yen Chiou Wen-Yen Chiou Liang-Cheng Chen Liang-Cheng Chen Liang-Cheng Chen Ru-Inn Lin Ru-Inn Lin Li-Wen Huang Li-Wen Huang Li-Wen Huang Chia-Hui Chew Chia-Hui Chew Chia-Hui Chew Feng-Chun Hsu Michael W. Y. Chan Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin |
| author_sort | Moon-Sing Lee |
| collection | DOAJ |
| description | Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials. |
| first_indexed | 2024-12-23T06:50:27Z |
| format | Article |
| id | doaj.art-8aa6a33b644f4405b1680f8cd70f1703 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-23T06:50:27Z |
| publishDate | 2020-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-8aa6a33b644f4405b1680f8cd70f17032022-12-21T17:56:27ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2020-02-01710.3389/fcvm.2020.00016520339Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary CareMoon-Sing Lee0Moon-Sing Lee1Dai-Wei Liu2Dai-Wei Liu3Shih-Kai Hung4Shih-Kai Hung5Shih-Kai Hung6Chih-Chia Yu7Chih-Chia Yu8Chen-Lin Chi9Chen-Lin Chi10Wen-Yen Chiou11Wen-Yen Chiou12Wen-Yen Chiou13Liang-Cheng Chen14Liang-Cheng Chen15Liang-Cheng Chen16Ru-Inn Lin17Ru-Inn Lin18Li-Wen Huang19Li-Wen Huang20Li-Wen Huang21Chia-Hui Chew22Chia-Hui Chew23Chia-Hui Chew24Feng-Chun Hsu25Michael W. Y. Chan26Hon-Yi Lin27Hon-Yi Lin28Hon-Yi Lin29Hon-Yi Lin30Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanDepartment of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanCancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Biomedical Sciences, National Chung Cheng University, Chia-Yi, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanDepartment of Anatomic Pathology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanCancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanCancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Biomedical Sciences, National Chung Cheng University, Chia-Yi, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanCancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanCancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Biomedical Sciences, National Chung Cheng University, Chia-Yi, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanCancer Centre, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, TaiwanDepartment of Biomedical Sciences, National Chung Cheng University, Chia-Yi, TaiwanRadiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.https://www.frontiersin.org/article/10.3389/fcvm.2020.00016/fullradiationcardiovascular dysfunctionmiRNAlate sequelaetoxicity |
| spellingShingle | Moon-Sing Lee Moon-Sing Lee Dai-Wei Liu Dai-Wei Liu Shih-Kai Hung Shih-Kai Hung Shih-Kai Hung Chih-Chia Yu Chih-Chia Yu Chen-Lin Chi Chen-Lin Chi Wen-Yen Chiou Wen-Yen Chiou Wen-Yen Chiou Liang-Cheng Chen Liang-Cheng Chen Liang-Cheng Chen Ru-Inn Lin Ru-Inn Lin Li-Wen Huang Li-Wen Huang Li-Wen Huang Chia-Hui Chew Chia-Hui Chew Chia-Hui Chew Feng-Chun Hsu Michael W. Y. Chan Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care Frontiers in Cardiovascular Medicine radiation cardiovascular dysfunction miRNA late sequelae toxicity |
| title | Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care |
| title_full | Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care |
| title_fullStr | Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care |
| title_full_unstemmed | Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care |
| title_short | Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care |
| title_sort | emerging challenges of radiation associated cardiovascular dysfunction racvd in modern radiation oncology clinical practice bench investigation and multidisciplinary care |
| topic | radiation cardiovascular dysfunction miRNA late sequelae toxicity |
| url | https://www.frontiersin.org/article/10.3389/fcvm.2020.00016/full |
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