No one wants to hear that they’ve been diagnosed with cancer, but advances in treating cancer with multiple therapies including chemotherapy, surgery and radiation continue to save lives. According to the American Cancer Society, the 5-year relative survival rate for all cancers diagnosed between 2002 and 2008 is 68 percent, and that’s a marked increase from the 49 percent documented between 1975 and 1977.
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Balancing Risks and Benefits
In health, you often hear about “risks and benefits.”Radiation therapy is a form of cancer treatment that uses strong beams of energy to kill cancer cells or keep them from growing and dividing. One of the risks of chest radiation therapy is that it can cause problems to the heart and cardiovascular system as long as 15 to 25 years after treatment. The condition is called radiation-induced heart disease, says Eric Roselli, M.D., a staff surgeon in Cleveland Clinic’s Department of Thoracic and Cardiovascular Surgery.
“Radiation can cause coronary artery disease, valve disease, and disease of the great vessels like the aorta or pulmonary trunk,” he says. “Those problems may require surgery.”
It’s always better to catch cardiac problems early in these patients, says Dr. Roselli. Guidelines published in September 2013 recommend screening and testing before and after radiation therapy. If you do have radiation-induced heart disease, you’ll want to locate a facility and surgeon with plenty of experience in treating this condition. Ideally one that’s published research data from its recent, relevant studies.
Smart Solutions to Complex Problems
“Many patients here at the Cleveland Clinic Heart & Vascular Institute may require what we call a multi-component operation that’s complex and includes procedures like coronary bypass surgery, a separate valve procedure, and even replacement of the aorta,” says Dr. Roselli.
Sometimes patients may also have experienced more severe effects on their lungs, and that—when combined with other factors—could increase risk during surgery.
“Patients may need more intensive care before, during and immediately following their operation, called the perioperative period. We also consider the extent of the radiation a patient may have been exposed to,” Dr. Roselli says.
When We’re All Different
Every patient is different, with different needs. When it’s indicated for high risk patients, surgeons will also consider therapies like transcatheter aortic valve replacement, when traditional open chest surgery isn’t recommended. Heart transplantation is yet another option, he says, and Cleveland Clinic has the third largest heart transplant program in the United States, and the largest in its home state of Ohio. During this procedure, surgeons remove the patient’s diseased heart and replace it with a new heart from a deceased donor.
With so many new options to treat radiation-induced heart disease, patients formerly helped by radiation have so many reasons to believe they will be helped again.