Cancer patients benefit from radiation therapy, but because of the effect of chest radiation on the heart, they can develop cardiovascular disease later in life. The medical community first identified cases of radiation-induced heart disease (RIHD) in the 1970s.
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Guidelines published in the September Journal of American Society of Echocardiography (JASE) discuss the risk of radiation-induced heart disease (RIHD), and stress the importance of screening and testing before and after therapy. Cleveland Clinic’s Juan Carlos Plana, MD, and Brian P. Griffin, MD, FACC, participated in the writing of the document.
Patient’s immune system contributes to coronary artery disease
Radiation therapy targeting the chest area (for example in breast and lung cancer) is more likely to cause RIHD. Ironically, it can be the patient’s own immune system, rushing to repair damage initially caused by exposure to radiation, that leads to inflammation in the blood vessels and eventual coronary artery disease.
Cancer survivors who received radiation therapy might develop coronary artery disease earlier in life than most people do, or have valvular disease (disease of the heart valves) or pericardial disease (disease of the sac that covers the heart), or damage to the heart muscle itself.
Higher doses of radiation increase heart risk
Higher doses and number of radiation treatments increase a patient’s risk of RIHD. Chemotherapy given in conjunction with radiation increases risk of RIHD. Lifestyle factors also influence the likelihood of patients developing RIHD, with smoking, obesity and high cholesterol all adding to the risk.
Symptoms can show up after 10 years
The new guidelines discuss which type of tests work best in detecting specific types of heart damage, and they also lay out a comprehensive plan to monitor patients over the years following treatment. Most patients don’t show symptoms of heart damage right away, but rather develop symptoms in about 10 years.
Recommendations for patients under new guidelines
- All patients should have an echocardiogram to establish a baseline before any treatment starts.
- Every patient should receive a yearly checkup and review of clinical history.
- Physicians should identify any lifestyle risk factors and seek to correct those risky behaviors (smoking, etc.).
- Even if the patient is younger than a typical “heart” patient, doctors should screen for symptoms suggestive of disease of the lining of the heart (pericardium), heart valve disease, heart failure, coronary and carotid artery disease and conduction system disease (problems with the “wiring” of the heart). Depending on the symptoms, the doctor will order another echocardiogram (in the case of new heart murmurs) or more advanced cardiac imaging, such as magnetic resonance scan (CMR), if considered necessary in the case of concern for pericardial constriction.
- Follow-ups should be every five years.
Dr. Plana states, “These guidelines will improve screening and intervention for RIHD.”