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CV screening recommended for cancer patients receiving chest radiation
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A new guideline recommends that patients with cancer receiving chest radiation should be screened for CVD every 5 to 10 years.
An expert task force of the European Association of Cardiovascular Imaging of the European Society of Cardiology and the American Society of Echocardiography has issued the first expert consensus statement on screening for radiation-induced heart disease.
“There is compelling evidence that chest radiotherapy can increase the risk of heart disease,” the panel wrote. “Although modern radiotherapy techniques are likely to reduce the prevalence and severity of radiation-induced heart disease, the incidence of radiation-induced heart disease is expected to increase in cancer survivors who have received old radiotherapy regimens. Improved knowledge of the prevalence of radiation-induced heart disease will help the medical community to better evaluate and inform patients of the risk of radiation-induced heart disease after chest radiotherapy.”
Patrizio Lancellotti
According to the new statement, the prevalence of radiation-induced heart disease is rising, as approximately 40% of cancer survivors have lived at least 10 years past their radiation treatments. Citing a previous study, the statement recognizes that 10% to 30% of patients receiving chest radiation develop radiation-induced heart disease within 5 to 10 years after treatment.
Long-term CV effects of chest radiation include pericarditis, cardiomyopathy, valve disease, CAD, carotid artery disease and other vascular diseases. For patients who have undergone such treatment, “their risk of death from CAD, myocardial ischemia and MI is increased,” Patrizio Lancellotti, MD, PhD, chairman of the expert task force, stated in a press release.
Patients at high risk for radiation-induced MI include those who have had radiation for left-sided breast cancer, received high doses of radiation or chemotherapy, did not have a shield on the irradiated area, or have CV risk factors such as smoking, obesity and inactivity, according to the statement.
Preventive strategies for radiation-induced MI cannot be recommended at this time because the underlying mechanisms are not yet known, the panel wrote. Therefore, current recommendations are focused on screening and examinations, such as:
- Patients should be screened for radiation-induced MI risk factors, have a clinical examination and undergo a baseline ECG evaluation before receiving chest radiation.
- Patients should undergo cardiac screening 5 years after treatment if they show any cardiac abnormality or are at high risk to develop radiation-induced MI. Otherwise, they should receive cardiac screening 10 years after treatment.
- Cardiac screening should be repeated every 5 years for those who are in a high-risk category or who show a cardiac abnormality, and every 10 years for others.
- Every patient who has received chest radiation for cancer in the past should undergo a cardiac examination, beginning with echocardiography. Some patients may also need stress imaging, CT or cardiac MRI.
For more information:
Lancellotti P. Eur Heart J Cardiovasc Imaging. 2013;14:721-740.
Disclosure: The task force members report no relevant financial disclosures.