Abstract
The authors of this report met at the Head Quarter of the International Atomic Energy Agency (IAEA) in Vienna, Austria, on 2–4 July 2012, for intensive discussions of an abundance of original publications on new epidemiological studies on cardiovascular effects after low-dose exposure and radiotherapy and radiobiological experiments as well as several comprehensive reviews that were published since the previous meeting by experts sponsored by the IAEA in June 2006. The data necessitated a re-evaluation of the situation with special emphasis on the consequences current experimental and clinical data may have for clinical oncology/radiotherapy and radiobiological research. The authors jointly arrived at the conclusions and recommendations presented here.
Similar content being viewed by others
References
Adams MJ, Hardenbergh PH, Constine LS, Lipshultz SE (2003) Radiation-associated cardiovascular disease. Crit Rev Oncol Hematol 45(1):55–75
Adams MJ, Lipsitz SR, Colan SD, Tarbell NJ, Treves ST, Diller L, Greenbaum N, Mauch P, Lipshultz SE (2004) Cardiovascular status in long-term survivors of Hodgkin’s disease treated with chest radiotherapy. J Clin Oncol 22(15):3139–3148
Adams MJ, Grant EJ, Kodama K, Shimizu Y, Kasagi F, Suyama A, Sakata R, Akahoshi M (2012) Radiation dose associated with renal failure mortality: a potential pathway to partially explain increased cardiovascular disease mortality observed after whole-body irradiation. Radiat Res 177(2):220–228
Azimzadeh O, Scherthan H, Sarioglu H, Barjaktarovic Z, Conrad M, Vogt A, Calzada-Wack J, Neff F, Aubele M, Buske C, Atkinson MJ, Tapio S (2011) Rapid proteomic remodeling of cardiac tissue caused by total body ionizing radiation. Proteomics 11(16):3299–3311
Azizova TV, Muirhead CR, Druzhinina MB, Grigoryeva ES, Vlasenko EV, Sumina MV, O’Hagan JA, Zhang W, Haylock RG, Hunter N (2010) Cerebrovascular diseases in the cohort of workers first employed at Mayak PA in 1948–1958. Radiat Res 174(6):851–864
Azizova TV, Fedirko V, Tsareva Y, Tretyakov F, Lassen CF, Friis S, Schuz J (2012) Mayak workers study cohort. An inter-institutional comparison of causes of death in the cause-of-death register of Ozyorsk in the Russian Federation. Methods Inf Med 51(2):144–149
Baker JE, Fish BL, Su J, Haworth ST, Strande JL, Komorowski RA, Migrino RQ, Doppalapudi A, Harmann L, Allen LX, Hopewell JW, Moulder JE (2009) 10 Gy total body irradiation increases risk of coronary sclerosis, degeneration of heart structure and function in a rat model. Int J Radiat Biol 85(12):1089–1100
Barjaktarovic Z, Schmaltz D, Shyla A, Azimzadeh O, Schulz S, Haagen J, Dorr W, Sarioglu H, Schafer A, Atkinson MJ, Zischka H, Tapio S (2011) Radiation-induced signaling results in mitochondrial impairment in mouse heart at 4 weeks after exposure to X-rays. PLoS ONE 6(12):e27811
Boerma M (2012) Experimental radiation-induced heart disease: past, present, and future. Radiat Res 178(1):1–6
Boerma M, Roberto KA, Hauer-Jensen M (2008) Prevention and treatment of functional and structural radiation injury in the rat heart by pentoxifylline and alpha-tocopherol. Int J Radiat Oncol Biol Phys 72(1):170–177
Borger JH, Hooning MJ, Boersma LJ, Snijders-Keilholz A, Aleman BM, Lintzen E, van Brussel S, van der Toorn PP, Alwhouhayb M, van Leeuwen FE (2007) Cardiotoxic effects of tangential breast irradiation in early breast cancer patients: the role of irradiated heart volume. Int J Radiat Oncol Biol Phys 69(4):1131–1138
Bouchardy C, Rapiti E, Usel M, Majno SB, Vlastos G, Benhamou S, Miralbell R, Neyroud-Caspar I, Verkooijen HM, Vinh-Hung V (2010) Excess of cardiovascular mortality among node-negative breast cancer patients irradiated for inner-quadrant tumors. Ann Oncol 21(3):459–465
Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106
Correa CR, Das IJ, Litt HI, Ferrari V, Hwang WT, Solin LJ, Harris EE (2008) Association between tangential beam treatment parameters and cardiac abnormalities after definitive radiation treatment for left-sided breast cancer. Int J Radiat Oncol Biol Phys 72(2):508–516
Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716
Early Breast Cancer Trialists’ Collaborative Group (2000) Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 355(9217):1757–1770
Fajardo LF, Stewart JR (1970) Experimental radiation-induced heart disease. I. Light microscopic studies. Am J Pathol 59(2):299–316
Gabriels K, Hoving S, Seemann I, Visser NL, Gijbels MJ, Pol JF, Daemen MJ, Stewart FA, Heeneman S (2012) Local heart irradiation of ApoE(−/−) mice induces microvascular and endocardial damage and accelerates coronary atherosclerosis. Radiother Oncol 105(3):358–364
Gagliardi G, Constine LS, Moiseenko V, Correa C, Pierce LJ, Allen AM, Marks LB (2010) Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 76(3 Suppl):S77–S85
Ghalibafian M, Beaudre A, Girinsky T (2008) Heart and coronary artery protection in patients with mediastinal Hodgkin lymphoma treated with intensity-modulated radiotherapy: dose constraints to virtual volumes or to organs at risk? Radiother Oncol 87(1):82–88
Ghobadi G, van der Veen S, Bartelds B, de Boer RA, Dickinson MG, de Jong JR, Faber H, Niemantsverdriet M, Brandenburg S, Berger RM, Langendijk JA, Coppes RP, van Luijk P (2012) Physiological interaction of heart and lung in thoracic irradiation. Int J Radiat Oncol Biol Phys 84(5):e639–e646
Hayashi T, Kusunoki Y, Hakoda M, Morishita Y, Kubo Y, Maki M, Kasagi F, Kodama K, MacPhee DG, Kyoizumi S (2003) Radiation dose-dependent increases in inflammatory response markers in A-bomb survivors. Int J Radiat Biol 79(2):129–136
Hendry JH, Akahoshi M, Wang LS, Lipshultz SE, Stewart FA, Trott KR (2008) Radiation-induced cardiovascular injury. Radiat Environ Biophys 47(2):189–193
Hilbers FS, Boekel NB, van den Broek AJ, van Hien R, Cornelissen S, Aleman BM, van ’tVeer LJ, van Leeuwen FE, Schmidt MK (2012) Genetic variants in TGFbeta-1 and PAI-1 as possible risk factors for cardiovascular disease after radiotherapy for breast cancer. Radiother Oncol 102(1):115–121
Hooning MJ, Botma A, Aleman BM, Baaijens MH, Bartelink H, Klijn JG, Taylor CW, van Leeuwen FE (2007) Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst 99(5):365–375
Hoving S, Heeneman S, Gijbels MJ, te Poele JA, Pol JF, Gabriels K, Russell NS, Daemen MJ, Stewart FA (2011) Anti-inflammatory and anti-thrombotic intervention strategies using atorvastatin, clopidogrel and knock-down of CD40L do not modify radiation-induced atherosclerosis in ApoE null mice. Radiother Oncol 101(1):100–108
Kusunoki Y, Hayashi T (2008) Long-lasting alterations of the immune system by ionizing radiation exposure: implications for disease development among atomic bomb survivors. Int J Radiat Biol 84(1):1–14
Lee MO, Song SH, Jung S, Hur S, Asahara T, Kim H, Kwon SM, Cha HJ (2012) Effect of ionizing radiation induced damage of endothelial progenitor cells in vascular regeneration. Arterioscler Thromb Vasc Biol 32(2):343–352
Little MP, Azizova TV, Bazyka D, Bouffler SD, Cardis E, Chekin S, Chumak VV, Cucinotta FA, de Vathaire F, Hall P, Harrison JD, Hildebrandt G, Ivanov V, Kashcheev VV, Klymenko SV, Kreuzer M, Laurent O, Ozasa K, Schneider T, Tapio S, Taylor AM, Tzoulaki I, Vandoolaeghe WL, Wakeford R, Zablotska LB, Zhang W, Lipshultz SE (2012) Systematic review and meta-analysis of circulatory disease from exposure to low-level ionizing radiation and estimates of potential population mortality risks. Environ Health Perspect 120(11):1503–1511
Liu H, Xiong M, Xia YF, Cui NJ, Lu RB, Deng L, Lin YH, Rong TH (2009) Studies on pentoxifylline and tocopherol combination for radiation-induced heart disease in rats. Int J Radiat Oncol Biol Phys 73(5):1552–1559
Machann W, Beer M, Breunig M, Stork S, Angermann C, Seufert I, Schwab F, Kolbl O, Flentje M, Vordermark D (2011) Cardiac magnetic resonance imaging findings in 20-year survivors of mediastinal radiotherapy for Hodgkin’s disease. Int J Radiat Oncol Biol Phys 79(4):1117–1123
Marks LB, Yu X, Prosnitz RG, Zhou SM, Hardenbergh PH, Blazing M, Hollis D, Lind P, Tisch A, Wong TZ, Borges-Neto S (2005) The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys 63(1):214–223
McChesney Gillette SL, Powers BE, Orton EC, Gillette EL (1991) Early radiation response of the canine heart and lung. Radiat Res 125(1):34–40
McChesney SL, Gillette EL, Orton EC (1988) Canine cardiomyopathy after whole heart and partial lung irradiation. Int J Radiat Oncol Biol Phys 14(6):1169–1174
McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM, Fornander T, Gigante B, Jensen MB, Peto R, Rahimi K, Taylor CW, Ewertz M (2011) Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol 100(2):167–175
McGeoghegan D, Binks K, Gillies M, Jones S, Whaley S (2008) The non-cancer mortality experience of male workers at British Nuclear Fuels plc, 1946–2005. Int J Epidemiol 37(3):506–518
Mitchel RE, Hasu M, Bugden M, Wyatt H, Little MP, Gola A, Hildebrandt G, Priest ND, Whitman SC (2011) Low-dose radiation exposure and atherosclerosis in ApoE(-)/(-) mice. Radiat Res 175(5):665–676
Mulrooney DA, Yeazel MW, Kawashima T, Mertens AC, Mitby P, Stovall M, Donaldson SS, Green DM, Sklar CA, Robison LL, Leisenring WM (2009) Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ 339:b4606
Preston DL, Shimizu Y, Pierce DA, Suyama A, Mabuchi K (2003) Studies of mortality of atomic bomb survivors. Report 13: solid cancer and noncancer disease mortality: 1950–1997. Radiat Res 160(4):381–407
Schellong G, Riepenhausen M, Bruch C, Kotthoff S, Vogt J, Bolling T, Dieckmann K, Potter R, Heinecke A, Bramswig J, Dorffel W (2010) Late valvular and other cardiac diseases after different doses of mediastinal radiotherapy for Hodgkin disease in children and adolescents: report from the longitudinal GPOH follow-up project of the German-Austrian DAL-HD studies. Pediatr Blood Cancer 55(6):1145–1152
Schollnberger H, Kaiser JC, Jacob P, Walsh L (2012) Dose-responses from multi-model inference for the non-cancer disease mortality of atomic bomb survivors. Radiat Environ Biophys 51(2):165–178
Schultz-Hector S (1991) Heart. In: Scherer E, Streffer Ch, Trott KR (eds) Medical radiology. Radiopathology of organs and tissues. Springer, Berlin
Schultz-Hector S (1992) Radiation-induced heart disease: review of experimental data on dose response and pathogenesis. Int J Radiat Biol 61(2):149–160
Seemann I, Gabriels K, Visser NL, Hoving S, te Poele JA, Pol JF, Gijbels MJ, Janssen BJ, van Leeuwen FW, Daemen MJ, Heeneman S, Stewart FA (2012) Irradiation induced modest changes in murine cardiac function despite progressive structural damage to the myocardium and microvasculature. Radiother Oncol 103(2):143–150
Shimizu Y, Kodama K, Nishi N, Kasagi F, Suyama A, Soda M, Grant EJ, Sugiyama H, Sakata R, Moriwaki H, Hayashi M, Konda M, Shore RE (2010) Radiation exposure and circulatory disease risk: Hiroshima and Nagasaki atomic bomb survivor data, 1950–2003. BMJ 340:b5349
Shukla J, Khan NM, Thakur VS, Poduval TB (2011) l-arginine mitigates radiation-induced early changes in cardiac dysfunction: the role of inflammatory pathways. Radiat Res 176(2):158–169
Soucy KG, Attarzadeh DO, Ramachandran R, Soucy PA, Romer LH, Shoukas AA, Berkowitz DE (2010) Single exposure to radiation produces early anti-angiogenic effects in mouse aorta. Radiat Environ Biophys 49(3):397–404
Tanteles GA, Whitworth J, Mills J, Peat I, Osman A, McCann GP, Chan S, Barwell JG, Talbot CJ, Symonds RP (2009) Can cutaneous telangiectasiae as late normal-tissue injury predict cardiovascular disease in women receiving radiotherapy for breast cancer? Br J Cancer 101(3):403–409
Taylor CW, McGale P, Povall JM, Thomas E, Kumar S, Dodwell D, Darby SC (2009) Estimating cardiac exposure from breast cancer radiotherapy in clinical practice. Int J Radiat Oncol Biol Phys 73(4):1061–1068
Tukenova M, Diallo I, Hawkins M, Guibout C, Quiniou E, Pacquement H, Dhermain F, Shamsaldin A, Oberlin O, de Vathaire F (2010) Long-term mortality from second malignant neoplasms in 5-year survivors of solid childhood tumors: temporal pattern of risk according to type of treatment. Cancer Epidemiol Biomarkers Prev 19(3):707–715
van Luijk P, Novakova-Jiresova A, Faber H, Schippers JM, Kampinga HH, Meertens H, Coppes RP (2005) Radiation damage to the heart enhances early radiation-induced lung function loss. Cancer Res 65(15):6509–6511
van Luijk P, Faber H, Meertens H, Schippers JM, Langendijk JA, Brandenburg S, Kampinga HH, Coppes RP (2007) The impact of heart irradiation on dose-volume effects in the rat lung. Int J Radiat Oncol Biol Phys 69(2):552–559
Wong FL, Yamada M, Sasaki H, Kodama K, Hosoda Y (1999) Effects of radiation on the longitudinal trends of total serum cholesterol levels in the atomic bomb survivors. Radiat Res 151(6):736–746
Zagar TM, Marks LB (2012) Breast cancer radiotherapy and coronary artery stenosis: location, location, location. J Clin Oncol 30(4):350–352
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wondergem, J., Boerma, M., Kodama, K. et al. Cardiovascular effects after low-dose exposure and radiotherapy: what research is needed?. Radiat Environ Biophys 52, 425–434 (2013). https://doi.org/10.1007/s00411-013-0489-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00411-013-0489-2