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Experts: Screen Heart After Chest Radiation

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Cancer patients who receive chest radiation should be screened for heart disease every 5 to 10 years, according to new recommendations by the European Society of Cardiology (ESC) and the American Society of Echocardiography (ASE).

The recommendations were published today in European Heart Journal—Cardiovascular Imaging and are scheduled to be published in the Journal of the American Society of Echocardiography. The article’s 23 co-authors work in cardiology, radiotherapy, and related fields across the United States and Europe.

Paradoxically, heart damage from cancer radiation therapy has become more of a problem because the therapy has gotten better. Patrizio Lancellotti, MD, PhD, chair of an expert task force that developed the recommendations, explained:

The prevalence of radiation-induced heart disease is increasing because the rate of cancer survival has improved. It’s a long-term risk, and RIHD manifests 5 to 20 years after the radiation dose.

Dr. Lancellotti is president of the European Association of Cardiovascular Imaging, which is part of the ESC. He was quoted in an ESC news release.

The release said radiation-induced heart disease occurs in an estimated 10 percent to 30 percent of chest radiotherapy patients within 5 to 10 years of treatment.

“Survivors of Hodgkin’s lymphoma and breast cancer received high doses of radiation on their chest under the old treatment regimes,” Dr. Lancelotti said. “Over time, these patients can develop RIHD in the heart valves, myocardium, vessels including the aorta, the pericardium, and the coronary arteries. Their risk of death from coronary artery disease, myocardial ischemia, and myocardial infarction is increased.”

Radiation doses are lower these days, but patients treated with radiation for lymphoma, breast cancer, esophageal cancer, and neck cancer are still at risk, Dr. Lancelotti said.

The expert panel recommends:

  • Before chest radiotherapy, patients should be screened for RIHD risk factors and have a clinical exam and a baseline echocardiogram.
  • Patients who receive chest radiation should have cardiac screening 5 years after treatment if they have any cardiac abnormality or are at high risk and 10 years after treatment otherwise. Patients are at high risk if they have had radiation for left-side breast cancer, have had a high dose of radiation, have been irradiated without shielding, have had a high dose of anthracyclines during chemotherapy, or have such cardiovascular risk factors as obesity, inactivity, and a history of smoking.
  • Cardiovascular screening should be repeated every 5 to 10 years, again depending on abnormalities and risk.
  • All patients who have had chest radiation for cancer should receive a cardiac exam starting with echocardiography.

Related CME seminar (up to 26.75 AMA PRA Category 1 credits™): Thoracic Imaging

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