Radiation therapy is a cornerstone of cancer therapy, with >50% of patients undergoing therapeutic radiation. As a result of widespread use and improved survival, there is increasing focus on the potential long-term effects of ionizing radiation, especially cardiovascular toxicity. Radiation therapy can lead to atherosclerosis of the vasculature as well as valvular, myocardial, and pericardial dysfunction. We present a consensus statement from the International Cardio-Oncology Society based on general principles of radiotherapy delivery and cardiovascular risk assessment and risk mitigation in this population. Anatomical-based recommendations for cardiovascular management and follow-up are provided, and a priority is given to the early detection of atherosclerotic vascular disease on imaging to help guide preventive therapy. Unique management considerations in radiation-induced cardiovascular disease are also discussed. Recommendations are based on the most current literature and represent a unanimous consensus by the multidisciplinary expert panel.
Keywords: CABG, coronary artery bypass graft; CAC, coronary artery calcium; CAD, coronary artery disease; CI, confidence interval; CT, computed tomography; CTCA, computed tomography coronary angiography; CV, cardiovascular; DIBH, deep inspiratory breath hold; HF, heart failure; HL, Hodgkin lymphoma; HNC, head and neck cancer; HR, hazard ratio; LIMA, left internal mammary artery; MRI, magnetic resonance imaging; NT-proBNP, N-terminal pro–B-type natriuretic peptide; OR, odds ratio; PAD, peripheral arterial disease; RT, radiation therapy; SAVR, surgical aortic valve replacement; SVC, superior vena cava; TAVR, transcatheter aortic valve replacement; TTE, transthoracic echocardiogram; aHR, adjusted hazard ratio; cancer; cardiovascular disease; imaging; prevention; radiation therapy; screening.
© 2021 The Authors.