Radiation-Induced Cardiovascular Toxicity: Mechanisms, Prevention, and Treatment

  • Johan Spetz
  • Javid Moslehi
  • Kristopher SarosiekEmail author
Cardio-oncology (M Fradley, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardio-oncology


Purpose of review

Ionizing radiation is a highly effective treatment for a wide range of malignancies, yet the cardiovascular (CV) toxicity that can result from chest radiotherapy impairs the long-term health of cancer survivors and can be a limiting factor for its use. Despite over 100 years of successful clinical use, the mechanisms by which high-energy photons damage critical components within cells of the heart’s myocardium, pericardium, vasculature, and valves remain unclear.

Recent findings

Recent studies exploring the acute and chronic effects of radiation therapy on cardiac and vascular tissue have provided new insights into the development and progression of heart disease, including the identification and understanding of age- and complication-associated risk factors. However, key questions relating to the connection from upstream signaling to fibrotic changes remain. In addition, advances in the delivery of chest radiotherapy have helped to limit heart exposure and damage, but additional refinements to delivery techniques and cardioprotective therapeutics are absolutely necessary to reduce patient mortality and morbidity.


Radiation therapy (RT)-driven CV toxicity remains a major issue for cancer survivors and more research is needed to define the precise mechanisms of toxicity. However, recent findings provide meaningful insights that may help improve patient outcomes.


Cardiotoxicity Cardiovascular toxicity Heart disease Heart failure Radiation therapy Apoptosis 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Johan Spetz
    • 1
    • 2
  • Javid Moslehi
    • 3
    • 4
    • 5
  • Kristopher Sarosiek
    • 1
    • 2
    Email author
  1. 1.John B. Little Center for Radiation SciencesHarvard T.H. Chan School of Public HealthBostonUSA
  2. 2.Laboratory of Systems Pharmacology, Harvard Program in Therapeutic Science, Department of Systems BiologyHarvard Medical SchoolBostonUSA
  3. 3.Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt-Ingram Cancer CenterVanderbilt University School of MedicineNashvilleUSA
  4. 4.Division of Hematology-Oncology, Department of Medicine, Vanderbilt-Ingram Cancer CenterVanderbilt University School of MedicineNashvilleUSA
  5. 5.Cardio-Oncology Program, Department of Medicine, Vanderbilt-Ingram Cancer CenterVanderbilt University School of MedicineNashvilleUSA

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