Cardiovascular effects of radiotherapy on the patient with cancer.

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.

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.

Cardiovascular assessment of hyperthyroid patients with multinodular goiter before and after radioiodine treatment preceded by stimulation with recombinant human TSH.

Treatment of large multinodular goiter (MNG) with radioiodine preceded by recombinant human thyrotropin (0.1 mg rhTSH) has been shown to be a safe alternative for patients with comorbidities that preclude surgery. However, the increase in serum thyroid hormones that follows both treatments may be harmful for some patients, particularly those with underlying cardiovascular disease. In this study, we evaluated cardiac parameters (clinical, ECG, 24-h Holter, Doppler echocardiogram, treadmill stress test) in 27 of 42 patients (ages 42-80 years) with large MNGs who were treated with rhTSH before receiving 30 mCi radioiodine therapy. At baseline, 18 patients had subclinical and six patients had overt iodine-induced hyperthyroidism. All patients had a transient surge in serum levels of free T4 and total T3 into the hyperthyroid range after therapy. However, repeated cardiac evaluation did not show significant changes as compared with baseline evaluation. In conclusion, rhTSH stimulated RAI treatment of MNG did not affect structural and functional parameters of the heart, despite transient high-serum levels of thyroid hormones.

EM waves standards effectiveness.

There are many studies about the effect of electromagnetic radiations on living organisms. Most of these have been carried out with mice, rats, guinea pigs, rabbits, dogs, monkeys, etc; only a limited amount of data is based on effects observed directly on human beings, which were mostly exposed to EM waves because of professional reasons (Epidemiology). In this paper some of these studies have been gathered according to the affected system. At higher frequencies power density is the parameter to be taken into account, at lower frequencies electric and magnetic field are, but in the graph they were expressed in terms of equivalent power density as ExH when both field strength were given, or as E2/Z or H2 Z (where Z is the free space impedance), when only one of them was given. Standards from different countries to human exposure are presented, and finally an analysis of the effects compared with standards from the U.S.A. and U.S.S.R. is presented.