Cardiovascular Effects of Childhood Radiotherapy

Cardiovascular disease is an important, well-studied late effect of childhood cancer therapy that may manifest many years after treatment. Radiotherapy, particularly when the heart is exposed, has been associated with multiple cardiovascular complications, including heart failure, coronary artery disease, valvular disease, and arrhythmias. This review examines the cardiovascular effects of radiotherapy in childhood and adolescent cancer survivors, with a focus on the mechanisms of radiation-induced injury, major cardiovascular outcomes, factors influencing long-term risk, and advances in cardiac-sparing radiotherapy and surveillance. The literature indicates radiotherapy was associated with an increased long-term risk of cardiovascular disease. Cardiovascular risk was influenced by radiation dose and the volume and location of cardiac tissue exposed, as well as age at treatment, anthracycline exposure, and traditional cardiovascular risk factors. Modern radiation techniques, including intensity-modulated and proton therapy, have aimed to reduce cardiac exposure. However, long-term clinical outcome data for these approaches remain limited. These findings support long-term cardiovascular surveillance of childhood cancer survivors and emphasize the importance of minimizing cardiac radiation exposure and addressing modifiable cardiovascular risk factors. Improved assessment of radiation dose to specific cardiac structures may further enable individualized risk stratification and surveillance.