Daher Jalil, Rizza Antonio, Tonacci Alessandro, Borghini Andrea
Department of Biology, Faculty of Arts and Sciences, University of Balamand, Balamand 100, Lebanon.
U.O.C. Cardiologia Diagnostica e Interventistica, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy.
Int J Mol Sci. 2025 Jun 4;26(11):5401. doi: 10.3390/ijms26115401.
Radiation-induced cardiac toxicity is a recognized complication in patients undergoing thoracic radiotherapy. A crucial manifestation of this toxicity is the damage caused to coronary arteries, which can result in accelerated atherosclerosis that may remain undetected for many years. As cancer survival rates continue to improve, the incidence of radiation-induced coronary artery disease (RICAD) is increasing, making it one of the leading causes of morbidity and mortality among patients treated with radiotherapy for mediastinal cancers. The pathophysiology of RICAD involves a complex interplay of cellular mechanisms, including endothelial dysfunction, inflammation, and fibrosis. These processes are related to several molecular insults such as DNA damage, telomere erosion, and mitochondrial dysfunction. However, to fully understand the initiation and progression of the disease, further research is critical to uncover additional contributing factors. Different strategies for preventing cardiovascular complications in cancer patients are gaining significant attention. Recent advancements in radiotherapy, particularly the new FLASH radiotherapy technique, show promise in reducing the incidence of these complications. This review focuses on the effects of radiotherapy on coronary artery disease, exploring the underlying cellular and molecular mechanisms, as well as potential strategies to prevent RICAD.
放射性心脏毒性是接受胸部放疗患者中一种公认的并发症。这种毒性的一个关键表现是对冠状动脉造成的损害，这可能导致加速动脉粥样硬化，而这种情况可能多年都未被发现。随着癌症生存率不断提高，放射性冠状动脉疾病（RICAD）的发病率正在上升，使其成为接受纵隔癌放疗患者发病和死亡的主要原因之一。RICAD的病理生理学涉及细胞机制的复杂相互作用，包括内皮功能障碍、炎症和纤维化。这些过程与多种分子损伤有关，如DNA损伤、端粒侵蚀和线粒体功能障碍。然而，要全面了解该疾病的发生和发展，进一步研究对于发现其他促成因素至关重要。预防癌症患者心血管并发症的不同策略正受到广泛关注。放疗领域的最新进展，尤其是新的FLASH放疗技术，有望降低这些并发症的发生率。本综述重点关注放疗对冠状动脉疾病的影响，探讨潜在的细胞和分子机制，以及预防RICAD的潜在策略。
