74 Chapter 5 The results of the current study emphasize the need to prevent the induction of radiation induced myocardial fibrosis by reducing the heart dose optimizing photon radiotherapy dose distributions or reduction of heart dose using proton radiotherapy.[42] Furthermore, early monitoring of myocardial fibrosis using EVC improves the detection of patients at risk. Future studies need to indicate whether treatment with anti-fibrotic agents such as angiotensin-converting enzyme and aldosterone inhibiters might be beneficial for these patients.[43] Conclusion We found a linear dose-effect relationship between myocardial ECV and mean radiation dose per myocardial segment of the left ventricle. Patients treated with nCRT followed by surgery had significantly increased mean global myocardial ECV measures compared to patients that were treated with surgery only. Therefore, this study demonstrates that EC survivors develop myocardial fibrosis as a direct consequence of co-irradiation to the heart.
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