Evidence-based cardiovascular management of patients receiving radiotherapy to the heart

Abstract

Historic and modern oncologic therapy techniques have the potential to adversely affect cardiovascular function. Depending on the disease, cancer therapy often requires radiotherapy (RT) to the chest, cardiotoxic chemotherapy, or both. A history of (or ongoing) RT to the heart may complicate the cardiovascular management of a patient. Radiotherapy is often thought to be selectively toxic to rapidly dividing cell populations, suggesting that tissues such as the heart and vessels would be relatively resistant. However, long-term outcome studies and more recent advances in imaging have given us a better understanding of the risks for both early and late cardiovascular complications of RT. While modern RT planning and treatment have reduced the dose to the heart, the risk to the cardiovascular system still remains. This review will attempt to give the reader comprehensive, up-to-date knowledge of the risks of RT to the heart, advances in treatment, advances in imaging for detecting adverse changes to the heart and the additive effects of chemotherapy, and other comorbidities on the effects of RT. Detailed recommendations are given for both the primary care physician as well as the cardiovascular team when managing patients who have received or are receiving RT to the heart.