Hug Your Heart after Cancer

Radiation induced heart disease a risk for cancer survivors who received chest radiation

Ways of treating cancer keep getting better all the time. That’s why there are more cancer survivors today than at any other time in history. Unfortunately, some older cancer treatments may be linked to long-term risks of other diseases.

Previous research has shown that cancer survivors who were treated with radiation to the chest may be at risk of developing heart disease years after their cancer treatment.
Two professional societies are now recommending survivors who received chest radiation be screened for heart disease every five to 10 years. How that screening should be performed has not been defined.

"Ask your oncologist about your heart health."

The European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology (ESC) and the American Society of Echocardiography (ASE) have issued an expert consensus statement regarding cardiovascular (heart) screening for what they call "radiation-induced heart disease" (RIHD).
Chest radiation is commonly used for treating breast cancer, Hodgkin’s lymphoma (a blood cancer) and esophageal cancer
According to Professor Patrizio Lancellotti, chair of the expert task force and president of the EACVI, these survivors "...received high doses of radiation on their chest under the old treatment regimes.
"The prevalence of radiation-induced heart disease [RIHD] is increasing because the rate of cancer survival has improved," he said. "It’s a long term risk, and RIHD manifests 5-20 years after the radiation dose.”
About 10 to 30 percent of survivors who received chest radiation are at risk of RIHD, according to the authors of this statement.
"There have been several other recent studies confirming that radiation therapy given to cure other cancers (i.e., lymphoma, breast) needs to be given in a technically optimized fashion in order to avoid unnecessary exposure to the heart," Frank Vicini, MD, FACR, radiation oncologist at 21st Century Oncology in Royal Oak, MI, told dailyRx News.
"Fortunately, with advanced techniques commonly in use today (i.e., three dimensional conformal treatment and intensity modulated radiation therapy), these concerns can be entirely avoided," Dr. Vicini said.
Three-dimensional (3D) conformal radiation therapy shapes the radiation beams to conform to the tumor. This spares the healthy nearby tissue from radiation exposure. Intensity-modulated radiation therapy (IMRT) works in a similar fashion, where the beams are sculpted and delivered in different segments to target the tumor while leaving nearby tissue alone.

"Patients need to be aware that despite results from studies like this, well designed and delivered radiation therapy does not result in an increased risk of heart disease,"  said Dr. Vicini, who is a dailyRx Contributing Expert.

While these professional societies recommend cardiac screening, this type of testing is not routine. The best strategies for screening and the types of screening tools that are best suited for cancer survivors have not yet been determined either. 
The authors suggest that echocardiography, a technology that uses sound waves to take moving pictures of the heart, may be best for initial evaluations.
Large prospective studies are needed to determine these details to "… enable targeted follow-up, screening and intervention," the authors wrote.
The consensus statement was published July 17 in the European Heart Journal - Cardiovascular Imaging. No financial assistance was provided for this effort and no conflicts of interest were disclosed.


Review Date: 
July 17, 2013