Chest Radiotherapy Associated Cardiotoxicity: An Update
- 1Cardiology Division, Hartford Hospital, University of Connecticut, Hartford, CT 06102 USA
- 2Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461 USA
- 3Cardiology Division, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 USA
Abstract
Purpose of Review: Chest radiotherapy has improved cancer survival in various thoracic malignancies, including breast cancer, Hodgkin lymphoma, and lung cancer. However, inadvertent radiation exposure to the heart is associated with a broad spectrum of cardiovascular toxicities, collectively termed radiation-induced heart disease (RIHD). We aim to review the pathophysiology of RIHD and the current evidence for their incidence, risk factors, clinical management, and prevention strategies.
Recent Findings: RIHD is mediated by oxidative stress, DNA damage, endothelial dysfunction, inflammation, and progressive fibrosis, leading to accelerated atherosclerosis, myocardial stiffening, valvular degeneration, pericardial disease, and arrhythmias. The risk, timing, and severity of cardiovascular complications are influenced by radiation dose and distribution, age at exposure, baseline cardiovascular risk, and concomitant cardiotoxic therapies. While younger patients may experience prolonged latency before clinical disease onset, older individuals and those with pre-existing cardiovascular disease often develop complications earlier, reflecting radiation-mediated acceleration of underlying pathology.
Summary: This review summarizes the epidemiology, latency, clinical presentation, surveillance strategies, and management of the different forms of RIHD. It also discusses contemporary approaches to risk mitigation, including advances in radiation delivery techniques, aggressive cardiovascular risk factor modification, lifestyle interventions, and emerging pharmacologic strategies.
Graphical Abstract:
Related
- Evaluation of Individualized Sequential Therapy Centered on Surgical Excision and Superficial Radiotherapy in Treating Keloids in the Anterior Chest Wall
- Machine learning predictors of post-radiotherapy cardiotoxicity in a Latin American breast cancer cohort: Clinical risk factors outperform cardiac dosimetry.
- Contemporary Management and Rechallenge Practices for 5‐Fluorouracil–Associated Cardiotoxicity: Insights From an International Cardio‐Oncology Society Survey
- Immune checkpoint inhibitor-associated cardiotoxicity: incidence, diagnosis, and management.
- Longitudinal Delta-Radiomics Identifies Treatment-Fraction-Associated Features Linked to Outcomes After Carbon-Ion Radiotherapy for Head and Neck Cancer
BibTeX
@article{agarwal2026chest,
title = {{Chest Radiotherapy Associated Cardiotoxicity: An Update}},
author = {Raksheeth Agarwal and Antony Gonzalo Gonzales-Uribe and Lili Zhang},
journal = {Current Cardiology Reports},
year = {2026},
month = oct,
doi = {10.1007/s11886-026-02437-6},
url = {https://doi.org/10.1007/s11886-026-02437-6},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Chest Radiotherapy Associated Cardiotoxicity: An Update
AU - Raksheeth Agarwal
AU - Antony Gonzalo Gonzales-Uribe
AU - Lili Zhang
PY - 2026
DA - 2026/10/27
JO - Current Cardiology Reports
DO - 10.1007/s11886-026-02437-6
UR - https://doi.org/10.1007/s11886-026-02437-6
AB - Purpose of Review: Chest radiotherapy has improved cancer survival in various thoracic malignancies, including breast cancer, Hodgkin lymphoma, and lung cancer. However, inadvertent radiation exposure to the heart is associated with a broad spectrum of cardiovascular toxicities, collectively termed radiation-induced heart disease (RIHD). We aim to review the pathophysiology of RIHD and the current evidence for their incidence, risk factors, clinical management, and prevention strategies. Recent Findings: RIHD is mediated by oxidative stress, DNA damage, endothelial dysfunction, inflammation, and progressive fibrosis, leading to accelerated atherosclerosis, myocardial stiffening, valvular degeneration, pericardial disease, and arrhythmias. The risk, timing, and severity of cardiovascular complications are influenced by radiation dose and distribution, age at exposure, baseline cardiovascular risk, and concomitant cardiotoxic therapies. While younger patients may experience prolonged latency before clinical disease onset, older individuals and those with pre-existing cardiovascular disease often develop complications earlier, reflecting radiation-mediated acceleration of underlying pathology. Summary: This review summarizes the epidemiology, latency, clinical presentation, surveillance strategies, and management of the different forms of RIHD. It also discusses contemporary approaches to risk mitigation, including advances in radiation delivery techniques, aggressive cardiovascular risk factor modification, lifestyle interventions, and emerging pharmacologic strategies. Graphical Abstract:
SN - 1523-3782
SN - 1534-3170
ER -