ABSTRACT
The focus of this chapter is to give a practical approach to oncologists and cardiologists in order to provide optimal care of patients before, during, and after radiation therapy. The wide spectrum of pathophysiology that may manifest as radiation-induced heart disease will also be discussed.
This chapter begins by addressing considerations before starting radiation therapy, including identification of patients at increased risk as well as preventative strategies to minimize risk before initiation of therapy. Next, we address considerations during radiation therapy, focusing on specific cancers, namely breast cancer, Hodgkin's lymphoma, lung cancer and esophageal (squamous cell) cancer. Particular attention is then turned to radiation-induced heart disease, including each affected cardiovascular tissue (namely the coronary arteries, capillaries, myocardium, valves, pericardium, and the conduction system), and we discuss how fibroinflammatory pathological changes following radiation exposure ultimately may result in a unique and high-risk heart failure syndrome. Finally, we discuss considerations after radiation therapy for survivors of cancer including guideline recommendations for follow-up of patients at risk of potentially cardiotoxic therapies.
Radiation therapy remains as an important part of treatment for breast cancer as well as for other malignancies of the thorax. With increased survivorship, comes additional emphasis on efforts to minimize particularly longer term cardiac toxicity. Advances in radiation technology, techniques, dosimetry, precautions, and patient selection have led to reductions in cardiac radiation dose. Given the latency in cardiac sequelae with radiation exposure, the benefits of modern radiation therapy protocols will likely be better demonstrated.
