Summary
The incidence of esophagus and stomach cancer is increasing; however, the novel multidisciplinary
management strategies and modern technology lead an increase in the low survival outcome. Radiotherapy
(RT) and chemotherapy (CT) are two essential parts of the multidisciplinary treatment which
helps to increase the outcome, but causes extra toxicities. Cardiac toxicity is one of the acute and lateterm
concerns that are being more important as survival increases. The free oxygen radicals produced by
irradiation which lead DNA damage and accompanying release of inflammatory factors cause cellular
changes and fibrosis with various pathophysiological effects. The CT agents have their own cardiotoxicity
mechanisms apart from the radiation damage of the irradiated portion of the heart. Both two types
of treatment have toxic effects on the cellular basis of the pericardium, cardiac vascular structures, muscles
of the heart, and the valvulas which turns into side effects such as pericardial effusion, myocardial
infarction, heart failure, and valvular dysfunction. It is essential to carefully evaluate the patients cardiac
condition before initiation of any the treatment modalities, use the most conformal RT technique which
is available and prefer the neoadjuvant treatment modalities which require less radiation doses to reduce
the cardiac toxicities. In addition, in the follow-up period, we must ensure that the patient is under the
control of not only the surgeon or the oncologist but also the cardiologist.
