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.
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.
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 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.
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.
Dr. Plana states, “These guidelines will improve screening and intervention for RIHD.”