Radiation-Induced Cardiac Remodeling: Mechanisms and Therapeutic Approaches

Radiation-induced cardiac remodeling (RICR) is one of the complications of exposure to radiotherapy. These disorders may occur for a subset of cancer patients, when the heart remains in part or in full in the radiation field. Despite advancements in radiotherapy techniques, cardiotoxicity has remained a concern after radiotherapy. RICR includes complex pathophysiological processes, which can be initiated by oxidative stress and cardiomyocyte cell death and continue with inflammation, arrhythmia, vascular and valvular abnormalities, and fibrosis, collectively contributing to structural and functional changes in the heart. Some studies have suggested strategies for RICR encompass pharmacological interventions, including angiotensin-converting enzyme (ACE) inhibitors, natural products, antioxidants, and others, which aim to mitigate cardiac damage and improve outcomes. Advanced therapies, including stem cell and gene therapy, as well as some adjuvants and novel drugs targeting specific molecular pathways, represent future directions for treatment. This review aims to elucidate the mechanisms underlying RICR, highlight early detection strategies, and discuss current and emerging therapeutic approaches.