Radiation-related neoplasms, circulatory diseases, and cataracts among radiological technologists

Background: In response to the need for diagnosis and treatment, medical radiation has been increasingly used worldwide. This study investigated the medical utilization of radiation-related diseases among radiological technologists [RTs] and factors that influence such diseases

Materials and Methods: Data were collected from the Taiwan National Health Insurance Research Database. A panel study was conducted with a sample of 3,432 RTs obtained in 2007 and followed up until 2011. Logistic regression applying generalized estimating equations was used for investigating the relationship between RTs and radiation-related diseases

Results: Among the RTs, the annual medical utilization rate of hospitalization for radiation-related neoplasms was 1.17%o-4.43%0, that for circulatory diseases was 4.68%o-11.50%o, and the annual medical utilization rate of outpatient visits for cataracts was 2.91%o-7.38%0. After sex, age, hospital accreditation level, and hospital ownership were controlled, the odds of hospitalization for neoplasms and circulatory diseases among the RTs were nonsignificantly higher than those of pharmacists, and the odds of outpatient visits for cataracts among the RTs were nonsignificantly lower than those of pharmacists

Conclusion: No sufficient evidence exists to substantiate the argument that the exposure of RTs to current doses of radiation could increase the risk of neoplasms, circulatory diseases, and cataracts. Considering the increased use of radiation treatment in current medical facilities, all speculation on occupational radiation-induced diseases must be further investigated and verified

Cardiovascular effects of radiotherapy on the patient with cancer / Efeitos cardiovasculares da radioterapia no paciente com câncer

Summary The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presentes a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals. Injuries caused by RT include diseases of the pericardium, coronary artery disease, valvular disease, myocardial disease with systolic and diastolic dysfunction, conduction disorders, and carotid artery and great vessels disease. Thoracic and cervical irradiation increases cardiovascular morbidity and mortality. Despite the great progress in the improvement of RT techniques, totally excluding prime areas of the cardiovascular system from the irradiation field is not yet possible. Guidelines must be created for monitoring, diagnosis and treatment of patients with CA treated with RT.

Resumo A incidência de câncer (CA) tem aumentado globalmente e a radioterapia (RT) é um componente vital do tratamento. As lesões cardiovasculares induzidas pela RT no tratamento de CA torácicos e cervicais geram problemas à prática clínica há décadas e estão entre os efeitos adversos mais graves da RT experimentados pelo crescente número de sobreviventes de CA. Neste artigo, realiza-se revisão nas bases Lilacs, Scielo e Pubmed das principais lesões cardiovasculares secundárias à RT, os mecanismos fisiopatológicos, as apresentações clínicas, os tratamentos e as propostas de prevenção. Dentre as lesões pela RT, destacam-se as doenças do pericárdio, a doença arterial coronariana, a doença valvular, a doença do miocárdio com disfunção sistólica e diastólica, os distúrbios de condução, a doença das artérias carótidas e dos grandes vasos. A irradiação torácica e cervical aumentam a morbimortalidade cardiovascular. Apesar da grande evolução no aprimoramento das técnicas de RT, ainda não foi possível excluir totalmente áreas nobres do sistema cardiovascular dos campos de irradiação. Faz-se necessária a instituição de diretrizes para monitoramento, diagnóstico e tratamento dos pacientes com CA submetidos à RT.

Open heart surgery after mediastinal radiation therapy

The use of radiation therapy has led to a significant improvement in the survival rate of patients treated for Hodgkin's disease, breast cancer and other malignances, however as patients live longer the potentially serious adverse effects of radiation on the heart raised increasing concern. A retrospective chart review was performed to compare two groups of patients, post mediastinal radiation therapy group [MRT] and patients who did not receive radiation [a control group] who underwent open heart surgery for postoperative complications and mortality. Radiation can affect all structures in the heart, coronaries, conductive system, valves and pericardium, we demonstrated an increase incidence of postoperative inotropic support and the need for pacemaker implantation as well as infection rate in MRT group compared to the control group, the mortality rate was higher as well. Patients who receive mediastinal radiation therapy before cardiac surgery suffer from more post-operative cardiac complications than patients who have not been exposed to radiation therapy

Early cardiac effects of radiotherapy following radial mastectomy in patients with carcinoma of the left breast

Nineteen patients with left breast cancer, who had no risk factors for coronary artery disease, underwent radical mastectomy followed by radiotherapy. Every patient received 50 Gy delivered to an inverted L-shaped field, from a cobalt-60 source. After radiotherapy, patients were followed for cardiac complications over an average observation period of 19.7 months. Of the 19 patients, five [26%] developed effusive pericarditis without cardiac tamponade. Echocardiography was superior to clinical examination and chest radiography for the detection and follow-up of pericardial effusions. Other cardiac complications reported to follow radiation injury to the heart were not observed and probably represent late effects of radiotherapy. In conclusion, patients with left breast cancer, especially those who have additional risk factors for coronary disease, may be at an increased risk of cardiac complications following radiotherapy. Suggestions for regular follow-up cardiac evaluation and irradiation treatment are discussed