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Cancer Patients with Cardiovascular Risk Factors Who Receive Chest Radiation Should Have Cardiovascular Screening Every 5 to 10 Years

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Key Points

  • Radiation-induced heart disease is estimated to occur in 10% to 30% of patients who receive chest radiotherapy within 5 to 10 years post-treatment.
  • The report recommends screening patients for radiation-induced heart disease risk factor before chest radiotherapy. Patients should receive cardiac screening 5 years post-treatment if they have any cardiac abnormality or are at high risk and 10 years post-treatment if not.
  • Patients are at high risk of radiation-induced heart disease if they have radiation for left-sided breast cancer, a high dose of radiation or anthracyclines, or cardiovascular risk factors, or if the irradiated area is not shielded.

Cancer patients who receive chest radiation should be screened for heart disease every 5 to 10 years, according to the European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology and the American Society of Echocardiography. Their recommendations are outlined in the first expert consensus statement on screening for radiation-induced heart disease, published in European Heart Journal – Cardiovascular Imaging.

“The prevalence of radiation-induced heart disease is increasing because the rate of cancer survival has improved. It’s a long-term risk, and radiation-induced heart disease manifests 5 to 20 years after the radiation dose,” said Patrizio Lancellotti, MD, PhD, Chair of the expert task force and President of the EACVI.

Dr. Lancellotti noted that under the old treatment regimens, patients with Hodgkin lymphoma and breast cancer received high doses of radiation to the chest, which leads to an increased risk of death from coronary artery disease, myocardial ischemia, and myocardial infarction.

Although radiotherapy is now given in lower doses, patients with lymphoma, breast cancer, and esophageal cancer are still at risk for radiation-induced heart disease, especially when the heart is in the radiation field, he said. “Patients who receive radiotherapy for neck cancer are also at risk because lesions can develop on the carotid artery and increase the risk of stroke,” he added.

Radiation-induced heart disease is estimated to occur in 10% to 30% of patients who receive chest radiotherapy within 5 to 10 years post-treatment. Cardiac structural and functional changes after radiation can be detected early using echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance, and nuclear cardiology. However, screening for radiation-induced heart disease is not routine practice.

Recommendations

In the report the expert group recommends:

  • Before initiating any chest radiotherapy, patients should have screening for radiation-induced heart disease risk factors, a clinical examination, and a baseline echocardiographic evaluation.
  • Patients who receive chest radiation for cancers including breast cancer or lymphoma should receive cardiac screening 5 years post-treatment if they have any cardiac abnormality or are at high risk and 10 years post-treatment if not.
  • Cardiovascular screening should be repeated every 5 to 10 years depending on the presence of cardiac abnormalities and the level of risk.
  • All patients who had chest radiation for cancer in the past should receive a cardiac examination starting with echocardiography.

Patients are at high risk of radiation-induced heart disease if they have radiation for left-sided breast cancer, a high dose of radiation (often used in young people) or anthracyclines, or cardiovascular risk factors (including smoking, obesity, and inactivity), or if the irradiated area is not shielded.

Raising Awareness of Cardiovascular Screening

“We wrote the expert consensus to raise the alarm that the risks of radiation-induced heart disease should not be ignored,” said Dr. Lancellotti. Cardiovascular screening is needed before and after radiation therapy to detect radiation-induced heart disease early, follow-up patients at appropriate intervals, and define the optimal timing for any kind of intervention.”

“A registry of radiation-induced heart disease is needed in Europe to determine the true prevalence of the disease and collect outcome data,” he concluded. “This together with screening should reduce the risk of patients developing radiation-induced heart disease and enable us to treat it early when it does occur.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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