Cardiovascular complications of radiation therapy for thoracic malignancies: The role for non-invasive imaging for detection of cardiovascular disease

European Heart Journal

Volumn 35, Issue 10, 2014, Pages 612-623

  Groarke, John D ^a   Nguyen, Paul L ^a   Nohria, Anju ^a,b   Ferrari, Roberto ^c   Cheng, Susan ^a   Moslehi, Javid ^a,b  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

^c UNIVERSITY HOSPITAL OF FERRARA   (Italy)

Author keywords

Non invasive imaging; Radiation therapy

Indexed keywords

CANCER RADIOTHERAPY; CARDIAC IMAGING; CARDIOMYOPATHY; CARDIOVASCULAR DISEASE; CORONARY ARTERY DISEASE; HEART DISEASE; HUMAN; PATHOPHYSIOLOGY; PERICARDIAL DISEASE; PREOPERATIVE CARE; PRIORITY JOURNAL; RADIATION DOSE; RADIATION INJURY; REVIEW; THORAX CANCER; VALVULAR HEART DISEASE; VASCULAR DISEASE;

NON-INVASIVE IMAGING; RADIATION THERAPY;

DIAGNOSTIC IMAGING; HEART DISEASES; HUMANS; PATIENT CARE PLANNING; PREOPERATIVE CARE; RADIATION DOSAGE; RADIATION INJURIES; THORACIC NEOPLASMS; VASCULAR DISEASES;

EID: 84898003439     PISSN: 0195668X     EISSN: 15229645     Source Type: Journal    
DOI: 10.1093/eurheartj/eht114     Document Type: Review

References (112)

1. Cutter DJ, Darby SC, Yusuf SW. Risks of heart disease after radiotherapy. Tex Heart Inst J 2011;38:257-258
2. Early Breast Cancer Trialists' Collaborative G, 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. Effect of radiotherapy after breastconserving 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 2011;378:1707-1716
3. Boice JD Jr. An affair of the heart. J Natl Cancer Inst 2007;99:186-187
4. Cohn KE, Stewart JR, Fajardo LF, Hancock EW. Heart disease following radiation. Medicine (Baltimore) 1967;46:281-298
5. Rademaker J, Schoder H, Ariaratnam NS, Strauss HW, Yahalom J, Steingart R, Oeffinger KC. Coronary artery disease after radiation therapy for Hodgkin's lymphoma: Coronary CT angiography findings and calcium scores in nine asymptomatic patients. AJR Am J Roentgenol 2008;191:32-37
6. Magne N, Chargari C, MacDermed D, Conforti R, Vedrine L, Spano JP, Khayat D. Tomorrow's targeted therapies in breast cancer patients: What is the risk for increased radiation-induced cardiac toxicity?. Crit Rev Oncol Hematol 2010;76: 186-195
7. Tamura A, Takahara Y, Mogi K, Katsumata M. Radiation-induced valvular disease is the logical consequence of irradiation. Gen Thorac Cardiovasc Surg 2007;55: 53-56
8. Nieder C, Schill S, Kneschaurek P, Molls M. Influence of different treatment techniques on radiation dose to the LAD coronary artery. Radiat Oncol 2007;2:20
9. Taylor CW, Nisbet A, McGale P, Goldman U, Darby SC, Hall P, Gagliardi G. Cardiac doses from Swedish breast cancer radiotherapy since the 1950s. Radiother Oncol 2009;90:127-135
10. Edwards-Bennett SM, Correa CR, Harris EE. Optimization of adjuvant radiation in breast conservation therapy: Can we minimize without compromise?. Int J Breast Cancer 2011;2011:321304
11. Koh ES, Tran TH, Heydarian M, Sachs RK, Tsang RW, Brenner DJ, Pintilie M, Xu T, Chung J, Paul N, Hodgson DC. A comparison of mantle versus involvedfield radiotherapy for Hodgkin's lymphoma: Reduction in normal tissue dose and second cancer risk. Radiat Oncol 2007;2:13
12. Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter JN, Horning SJ, Dar AR, Shustik C, Stewart DA, Crump M, Djurfeldt MS, Chen BE, Shepherd LE, Group NCT, Eastern Cooperative Oncology G. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. N Engl J Med 2012;366:399-408
13. Eich HT, Kriz J, Muller RP. Evolution of radiation therapy within the German Hodgkin Study Group trials. J Natl Compr Canc Netw 2011;9:1073-1080
14. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, Correa C, Cutter D, Gagliardi G, Gigante B, Jensen MB, Nisbet A, Peto R, Rahimi K, Taylor C, Hall P. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013;368:987-998
15. Darby SC, Cutter DJ, Boerma M, Constine LS, Fajardo LF, Kodama K, Mabuchi K, Marks LB, Mettler FA, Pierce LJ, Trott KR, Yeh ET, Shore RE. Radiation-related heart disease: Current knowledge and future prospects. Int J Radiat Oncol Biol Phys 2010;76:656-665.
16. Di Matteo J, Vacheron A, Heulin A, Meeus L, Di Matteo G, Gilles R, Delage F, De Ratuld A. Cardiac complications of thoracic radiotherapy. Arch Mal Coeur Vaiss 1978;71:447-452
17. Barbetakis N, Xenikakis T, Paliouras D, Asteriou C, Samanidis G, Kleontas A, Lafaras C, Platogiannis D, Bischiniotis T, Tsilikas C. Pericardiectomy for radiation-induced constrictive pericarditis. Hellenic J Cardiol 2010;51:214-218
18. Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, Tajik AJ. Constrictive pericarditis in the modern era: Evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 1999;100:1380-1386
19. Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, Lytle BW, Blackstone EH, Lauer MS, Klein AL. Constrictive pericarditis: Etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol 2004;43:1445-1452
20. Ni Y, von Segesser LK, Turina M. Futility of pericardiectomy for postirradiation constrictive pericarditis?. Ann Thorac Surg 1990;49:445-448
21. Veinot JP, Edwards WD. Pathology of radiation-induced heart disease: A surgical and autopsy study of 27 cases. Hum Pathol 1996;27:766-773
22. Orzan F, Brusca A. Radiation-induced constrictive pericarditis. Associated cardiac lesions, therapy and follow-up. G Ital Cardiol 1994;24:817-823
23. Veeragandham RS, Goldin MD. Surgical management of radiation-induced heart disease. Ann Thorac Surg 1998;65:1014-1019
24. Yared K, Baggish AL, Picard MH, Hoffmann U, Hung J. Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging 2010;3:650-660
25. Masui T, Finck S, Higgins CB. Constrictive pericarditis and restrictive cardiomyopathy: Evaluation with MR imaging. Radiology 1992;182:369-373
26. Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK. Pericardial disease: Diagnosis and management. Mayo Clin Proc 2010;85: 572-593
27. Napolitano G, Pressacco J, Paquet E. Imaging features of constrictive pericarditis: Beyond pericardial thickening. Can Assoc Radiol J 2009;60:40-46
28. Oyama N, Oyama N, Komuro K, Nambu T, Manning WJ, Miyasaka K. Computed tomography and magnetic resonance imaging of the pericardium: Anatomy and pathology. Magn Reson Med Sci 2004;3:145-152
29. Chinnasami BR, Schwartz RC, Pink SB, Skotnicki RA. Isolated left main coronary stenosis and mediastinal irradiation. Clin Cardiol 1992;15:459-461
30. Pilliere R, Luquel L, Brun D, Jault F, Gandjbakhch I, Bourdarias JP. Ostial stenosis of the left main coronary artery after mediastinal radiotherapy. Apropos of a case. Arch Mal Coeur Vaiss 1991;84:869-872
31. Radwaner BA, Geringer R, Goldmann AM, Schwartz MJ, Kemp HG Jr. Left main coronary artery stenosis following mediastinal irradiation. Am J Med 1987;82: 1017-1020
32. Wan SK, Babb JD. Radiation-induced stenosis of the left main coronary artery. Cathet Cardiovasc Diagn 1993;28:225-227
33. Orzan F, Brusca A, Conte MR, Presbitero P, Figliomeni MC. Severe coronary artery disease after radiation therapy of the chest and mediastinum: Clinical presentation and treatment. Br Heart J 1993;69:496-500
34. Seddon B, Cook A, Gothard L, Salmon E, Latus K, Underwood SR, Yarnold J. Detection of defects in myocardial perfusion imaging in patients with early breast cancer treated with radiotherapy. Radiother Oncol 2002;64:53-63
35. Reinders JG, Heijmen BJ, Olofsen-Van Acht MJ, Van Putten WL, Levendag PC. Ischemic heart disease after mantlefield irradiation for Hodgkin's disease in longterm follow-up. Radiother Oncol 1999;51:35-42
36. Hancock SL, Tucker MA, Hoppe RT. Factors affecting late mortality from heart disease after treatment of Hodgkin's disease. JAMA 1993;270:1949-1955
37. Heidenreich PA, Schnittger I, Strauss HW, Vagelos RH, Lee BK, Mariscal CS, Tate DJ, Horning SJ, Hoppe RT, Hancock SL. Screening for coronary artery disease after mediastinal irradiation for Hodgkin's disease. J Clin Oncol 2007;25: 43-49
38. Hardenbergh PH, Munley MT, Bentel GC, Kedem R, Borges-Neto S, Hollis D, Prosnitz LR, Marks LB. Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: Preliminary results. Int J Radiat Oncol Biol Phys 2001;49:1023-1028
39. Sioka C, Exarchopoulos T, Tasiou I, Tzima E, Fotou N, Capizzello A, Ragos V, Tsekeris P, Fotopoulos A. Myocardial perfusion imaging with (99 m)Tc-tetrofosmin SPECT in breast cancer patients that received postoperative radiotherapy: A case-control study. Radiat Oncol 2011;6:151
40. Yu X, Prosnitz RR, Zhou S, Hardenberg PH, Tisch A, Blazing MA, Borges-Neto S, Hollis D, Wong T, Marks LB. Symptomatic cardiac events following radiation therapy for left-sided breast cancer: Possible association with radiation therapy-induced changes in regional perfusion. Clin Breast Cancer 2003;4: 193-197
41. Schinkel AF, Elhendy A, Van Domburg RT, Bax JJ, Vourvouri EC, Bountioukos M, Rizzello V, Agricola E, Valkema R, Roelandt JR, Poldermans D. Incremental value of exercise technetium-99m tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of cardiac events. Am J Cardiol 2003;91:408-411
42. Jain D, Lessig H, Patel R, Sandler L, Weiland F, Edell SL, Elizabeth Oates M, O'Malley-Tysko E, Khutoryansky N, Jacobson AF. Influence of 99mTc-tetrofosmin SPECT myocardial perfusion imaging on the prediction of future adverse cardiac events. J Nucl Cardiol 2009;16:540-548
43. Lind PA, Pagnanelli R, Marks LB, Borges-Neto S, Hu C, Zhou SM, Light K, Hardenbergh PH. Myocardial perfusion changes in patients irradiated for leftsided breast cancer and correlation with coronary artery distribution. Int J Radiat Oncol Biol Phys 2003;55:914-920
44. Van Leeuwen-Segarceanu EM, Bos WJ, Dorresteijn LD, Rensing BJ, der Heyden JA, Vogels OJ, Biesma DH. Screening Hodgkin lymphoma survivors for radiotherapy induced cardiovascular disease. Cancer Treat Rev 2011;37: 391-403
45. Carlson RG, Mayfield WR, Normann S, Alexander JA. Radiation-Associated valvular disease. Chest 1991;99:538-545
46. Reber D, Birnbaum DE, Tollenaere P. Heart diseases following mediastinal irradiation: Surgical management. Eur J Cardiothorac Surg 1995;9:202-205
47. Glanzmann C, Kaufmann P, Jenni R, Hess OM, Huguenin P. Cardiac risk after mediastinal irradiation for Hodgkin's disease. Radiother Oncol 1998;46:51-62
48. Hull MC, Morris CG, Pepine CJ, Mendenhall NP. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. JAMA 2003;290:2831-2837
49. Jahangiri M, Edmondson SJ, Rees GM. Surgery for radiation-induced valvular disease. J Heart Valve Dis 1995;4:288-290
50. Mezzaroma E, Di X, Graves P, Toldo S, Van Tassell BW, Kannan H, Baumgarten C, Voelkel N, Gewirtz DA, Abbate A. A mouse model of radiation-induced cardiomyopathy. Int J Cardiol 2012;156:231-233
51. Monceau V, Pasinetti N, Schupp C, Pouzoulet F, Opolon P, Vozenin MC. Modulation of the Rho/ROCK pathway in heart and lung after thorax irradiation reveals targets to improve normal tissue toxicity. Curr Drug Targets 2010;11: 1395-1404
52. 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. Irradiation induced modest changes in murine cardiac function despite progressive structural damage to the myocardium and microvasculature. Radiother Oncol 2012; 103:143-150
53. Lipshultz SE, Adams MJ. Cardiotoxicity after childhood cancer: Beginning with the end in mind. J Clin Oncol 2010;28:1276-1281
54. Velensek V, Mazic U, Krzisnik C, Demsar D, Jazbec J, Jereb B. Cardiac damage after treatment of childhood cancer: A long-term follow-up. BMC Cancer 2008; 8:141
55. Erven K, Florian A, Slagmolen P, Sweldens C, Jurcut R, Wildiers H, Voigt JU, Weltens C. Subclinical cardiotoxicity detected by strain rate imaging up to 14 months after breast radiation therapy. Int J Radiat Oncol Biol Phys 2013;85: 1172-1178
56. Plummer C, Henderson RD, O'Sullivan JD, Read SJ. Ischemic stroke and transient ischemic attack after head and neck radiotherapy: A review. Stroke 2011;42: 2410-2418
57. Li CS, Schminke U, Tan TY. Extracranial carotid artery disease in nasopharyngeal carcinoma patients with post-irradiation ischemic stroke. Clin Neurol Neurosurg 2010;112:682-686
58. Scott AS, Parr LA, Johnstone PA. Risk of cerebrovascular events after neck and supraclavicular radiotherapy: A systematic review. Radiother Oncol 2009;90: 163-165
59. De Bruin ML, Dorresteijn LD, van't Veer MB, Krol AD, Van Der Pal HJ, Kappelle AC, Boogerd W, Aleman BM, Van Leeuwen FE. Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma. J Natl Cancer Inst 2009;101:928-937
60. Bowers DC, McNeil DE, Liu Y, Yasui Y, Stovall M, Gurney JG, Hudson MM, Donaldson SS, Packer RJ, Mitby PA, Kasper CE, Robison LL, Oeffinger KC. Stroke as a late treatment effect of Hodgkin's Disease: A report from the Childhood Cancer Survivor Study. J Clin Oncol 2005;23:6508-6515
61. Hassen-Khodja R, Kieffer E, University Association for Research in Vascular S. Radiotherapy-induced supra-Aortic trunk disease: Early and long-term results of surgical and endovascular reconstruction. J Vasc Surg 2004;40:254-261
62. Hashmonai M, Elami A, Kuten A, Lichtig C, Torem S. Subclavian artery occlusion after radiotherapy for carcinoma of the breast. Cancer 1988;61:2015-2018
63. Abayomi OK. Neck irradiation, carotid injury and its consequences. Oral Oncol 2004;40:872-878
64. Cheng SW, Wu LL, Ting AC, Lau H, Lam LK,Wei WI. Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies. Am J Surg 1999;178:323-328
65. Tallarita T, Oderich GS, Lanzino G, Cloft H, Kallmes D, Bower TC, Duncan AA, Gloviczki P. Outcomes of carotid artery stenting versus historical surgical controls for radiation-induced carotid stenosis. J Vasc Surg 2011;53:629-636 e1-e5
66. Benitez RP, Armonda RA, Harrop J, Thomas JE, Rosenwasser RH. Carotid angioplasty and stenting for recurrent and radiation-induced stenosis: Preliminary experience. Neurosurg Focus 1998;5:e14
67. Cohen JE, Rajz G, Lylyk P, Ben-Hur T, Gomori JM, Umansky F. Protected stent-Assisted angioplasty in radiation-induced carotid artery stenosis. Neurol Res 2005;27(Suppl. 1):S69-S72
68. Melliere D, Becquemin JP, Berrahal D, Desgranges P, Cavillon A. Management of radiation-induced occlusive arterial disease: A reassessment. J Cardiovasc Surg (Torino) 1997;38:261-269
69. White RA, Sicard GA, Zwolak RM, Sidawy AN, Schermerhorn ML, Shackelton RJ, Siami FS, Committee SVSO. Society of vascular surgery vascular registry comparison of carotid artery stenting outcomes for atherosclerotic vs nonatherosclerotic carotid artery disease. J Vasc Surg 2010;51:1116-1123
70. Dorresteijn LD, Vogels OJ, De Leeuw FE, Vos JA, Christiaans MH, Ackerstaff RG, Kappelle AC. Outcome of carotid artery stenting for radiation-induced stenosis. Int J Radiat Oncol Biol Phys 2010;77:1386-1390
71. Sadek M, Cayne NS, Shin HJ, Turnbull IC, Marin ML, Faries PL. Safety and efficacy of carotid angioplasty and stenting for radiation-Associated carotid artery stenosis. J Vasc Surg 2009;50:1308-1313
72. Shin SH, Stout CL, Richardson AI, DeMasi RJ, Shah RM, Panneton JM. Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis. J Vasc Surg 2009;50:762-767; discussion 767-768
73. Favre JP, Nourissat A, Duprey A, Nourissat G, Albertini JN, Becquemin JP, Association Universitaire De Recherche en Chirurgie V. Endovascular treatment for carotid artery stenosis after neck irradiation. J Vasc Surg 2008;48:852-858
74. Leseche G, Castier Y, Chataigner O, Francis F, Besnard M, Thabut G, Abdalla E, Cerceau O. Carotid artery revascularization through a radiated field. J Vasc Surg 2003;38:244-250
75. Lam WW, Leung SF, So NM, Wong KS, Liu KH, Ku PK, Yuen HY, Metreweli C. Incidence of carotid stenosis in nasopharyngeal carcinoma patients after radiotherapy. Cancer 2001;92:2357-2363
76. Bootz F, Diener HC. Radiation-induced damage to the large arteries. HNO 1987; 35:24-26
77. Chang YJ, Chang TC, Lee TH, Ryu SJ. Predictors of carotid artery stenosis after radiotherapy for head and neck cancers. J Vasc Surg 2009;50:280-285
78. Steele SR, Martin MJ, Mullenix PS, Crawford JV, Cuadrado DS, Andersen CA. Focused high-risk population screening for carotid arterial stenosis after radiation therapy for head and neck cancer. Am J Surg 2004;187:594-598
79. Carmody BJ, Arora S, Avena R, Curry KM, Simpkins J, Cosby K, Sidawy AN. Accelerated carotid artery disease after high-dose head and neck radiotherapy: Is there a role for routine carotid duplex surveillance?. J Vasc Surg 1999;30: 1045-1051
80. Cheng SW, Ting AC, Ho P, Wu LL. Accelerated progression of carotid stenosis in patients with previous external neck irradiation. J Vasc Surg 2004;39:409-415
81. McEniery PT, Dorosti K, Schiavone WA, Pedrick TJ, Sheldon WC. Clinical and angiographic features of coronary artery disease after chest irradiation. Am J Cardiol 1987;60:1020-1024
82. Kleikamp G, Schnepper U, Korfer R. Coronary artery and aortic valve disease as a long-term sequel of mediastinal and thoracic irradiation. Thorac Cardiovasc Surg 1997;45:27-31
83. Mack MJ. Risk scores for predicting outcomes in valvular heart disease: How useful?. Curr Cardiol Rep 2011;13:107-112
84. Kamdar AR, Meadows TA, Roselli EE, Gorodeski EZ, Curtin RJ, Sabik JF, Schoenhagen P, White RD, Lytle BW, Flamm SD, Desai MY. Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery. Ann Thorac Surg 2008;85:1239-1245
85. Khan NU, Yonan N. Does preoperative computed tomography reduce the risks associated with re-do cardiac surgery?. Interact Cardiovasc Thorac Surg 2009;9: 119-123
86. Van Son JA, Noyez L, Van Asten WN. Use of internal mammary artery in myocardial revascularization after mediastinal irradiation. J Thorac Cardiovasc Surg 1992;104:1539-1544
87. Hicks GL Jr. Coronary artery operation in radiation-Associated atherosclerosis: Long-term follow-up. Ann Thorac Surg 1992;53:670-674
88. Apter S, Shemesh J, Raanani P, Portnoy O, Thaler M, Zissin R, Ezra D, Rozenman J, Pfeffer R, Hertz M. Cardiovascular calcifications after radiation therapy for Hodgkin lymphoma: Computed tomography detection and clinical correlation. Coron Artery Dis 2006;17:145-151
89. Daitoku K, Fukui K, Ichinoseki I, Munakata M, Takahashi S, Fukuda I. Radiotherapy-induced aortic valve disease associated with porcelain aorta. Jpn J Thorac Cardiovasc Surg 2004;52:349-352
90. Buz S, Pasic M, Unbehaun A, Drews T, Dreysse S, Kukucka M, Mladenow A, Hetzer R. Trans-Apical aortic valve implantation in patients with severe calcification of the ascending aorta. Eur J Cardiothorac Surg 2011;40:463-468
91. Kempfert J, Van Linden A, Linke A, Schuler G, Rastan A, Lehmann S, Lehmkuhl L, Mohr FW, Walther T. Transapical aortic valve implantation: Therapy of choice for patients with aortic stenosis and porcelain aorta?. Ann Thorac Surg 2010;90: 1457-1461
92. Kolettis TN, Spargias K, Stavridis GT. Combined transapical aortic valve implantation with coronary artery bypass grafting in a young patient with porcelain aorta. Hellenic J Cardiol 2009;50:79-82
93. Brenner DJ, Hall EJ. Computed tomography-An increasing source of radiation exposure. N Engl J Med 2007;357:2277-2284
94. Marti JL, Dauer LT, Stempel M, Patil S, Kaplan JB, Montgomery LL. Cumulative imaging radiation exposure following breast-conservation therapy. Ann Surg Oncol 2011;18:104-108
95. Gaya AM, Ashford RF. Cardiac complications of radiation therapy. Clin Oncol (R Coll Radiol) 2005;17:153-159
96. Moslehi J. The cardiovascular perils of cancer survivorship. N Engl J Med 2013; 368:1055-1056
97. Curigliano G, Cardinale D, Suter T, Plataniotis G, De Azambuja E, Sandri MT, Criscitiello C, Goldhirsch A, Cipolla C, Roila F, Group EGW. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Ann Oncol 2012;23(Suppl. 7):vii155-Vii166
98. NationalComprehensive CancerNetworkClinical PracticeGuidelines inOncology: Hodgkins Lymphoma Version 2.2012. http://www.nccn.org/professionals/ physician-gls/pdf/hodgkins.pdf. (19 November 2012)
99. Maunoury C, Pierga JY, Valette H, Tchernia G, Cosset JM, Desgrez A. Myocardial perfusion damage after mediastinal irradiation for Hodgkin's disease: A thallium-201 single photon emission tomography study. Eur J Nucl Med 1992; 19:871-873
100. Gustavsson A, Eskilsson J, Landberg T, Svahn-Tapper G, White T, Wollmer P, Akerman M. Late cardiac effects after mantle radiotherapy in patients with Hodgkin's disease. Ann Oncol 1990;1:355-363
101. Gyenes G, Fornander T, Carlens P, Rutqvist LE. Morbidity of ischemic heart disease in early breast cancer 15-20 years after adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 1994;28:1235-1241
102. Constine LS, Schwartz RG, Savage DE, King V, Muhs A. Cardiac function, perfusion, and morbidity in irradiated long-term survivors of Hodgkin's disease. Int J Radiat Oncol Biol Phys 1997;39:897-906
103. Cowen D, Gonzague-Casabianca L, Brenot-Rossi I, Viens P, Mace L, Hannoun-Levi JM, Alzieu C, Resbeut M. Thallium-201 perfusion scintigraphy in the evaluation of late myocardial damage in left-side breast cancer treated with adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 1998;41:809-815
104. Marks LB, Yu X, Prosnitz RG, Zhou SM, Hardenbergh PH, Blazing M, Hollis D, Lind P, Tisch A, Wong TZ, Borges-Neto S. The incidence and functional consequences of RT-Associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys 2005;63:214-223
105. Prosnitz RG, Hubbs JL, Evans ES, Zhou SM, Yu X, Blazing MA, Hollis DR, Tisch A, Wong TZ, Borges-Neto S, Hardenbergh PH, Marks LB. Prospective assessment of radiotherapy-Associated cardiac toxicity in breast cancer patients: Analysis of data 3 to 6 years after treatment. Cancer 2007;110:1840-1850
106. Andersen R, Wethal T, Gunther A, Fossa A, Edvardsen T, Fossa SD, Kjekshus J. Relation of coronary artery calcium score to premature coronary artery disease in survivors .15 years of Hodgkin's lymphoma. Am J Cardiol 2010;105:149-152
107. Kupeli S, Hazirolan T, Varan A, Akata D, Alehan D, Hayran M, Besim A, Buyukpamukcu M. Evaluation of coronary artery disease by computed tomography angiography in patients treated for childhood Hodgkin's lymphoma. J Clin Oncol 2010;28:1025-1030
108. Kim KP, Einstein AJ, Berrington De Gonzalez A. Coronary artery calcification screening: Estimated radiation dose and cancer risk. Arch Intern Med 2009;169: 1188-1194
109. Sun Z, Ng KH. Coronary computed tomography angiography in coronary artery disease. World J Cardiol 2011;3:303-310
110. Einstein AJ. Effects of radiation exposure from cardiac imaging how good are the data? J Am Coll Cardiol 2012;59:553-565
111. Berrington De Gonzalez A, Kim KP, Smith-Bindman R, McAreavey D. Myocardial perfusion scans: Projected population cancer risks from current levels of use in the United States. Circulation 2010;122:2403-2410
112. Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: A catalog. Radiology 2008;248:254-263.