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Cardiotoxicity of Radiation Therapy: Mechanisms, Management, and Mitigation

  • Cardio-oncology (MG Fradley, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion Statement

Radiation therapy is a key component of modern-day cancer therapy and can reduce the rates of recurrence and death from cancer. However, it can increase risk of cardiovascular (CV) events, and our understanding of the timeline associated with that risk is shorter than previously thought. Risk mitigation strategies, such as different positioning techniques, and breath hold acquisitions as well as baseline cardiovascular risk stratification that can be undertaken at the time of radiotherapy planning should be implemented, particularly for patients receiving chest radiation therapy. Primary and secondary prevention of cardiovascular disease (CVD), as appropriate, should be used before, during, and after radiation treatment in order to minimize the risks. Opportunistic screening for subclinical coronary disease provides an attractive possibility for primary/secondary CVD prevention and thus mitigation of long-term CV risk. More data on long-term clinical usefulness of this strategy and development of appropriate management pathways would further strengthen the evidence for the implementation of such screening. Clear guidelines in initial cardiovascular screening and cardiac aftercare following radiotherapy need to be formulated in order to integrate these measures into everyday clinical practice and policy and subsequently improve post-treatment morbidity and mortality for these patients.

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Funding

This work is supported in part by the National Heart Foundation Future Leader Fellowships (DTMN [104814] and ALS [101918]), NSW Health EMCR Fellowship (DTMN), NSW Health Cardiovascular Capacity Building EMC Grant (ALS), Hunter Cancer Research Alliance New Strategic Initiatives Grant (ALS and DTMN), and John Hunter Charitable Trust Grants (DTMN and ALS).

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Authors and Affiliations

  1. GenesisCare, Lake Macquarie Private Hospital, Gateshead, NSW, Australia

    P. Ell BAppSc(MRS)NucMed, MBBS, GradCertClinEpi, FRANZCR & J. M. Martin MBChB, BSc, PhD, DMed, FRANZCR, GAustMS

  2. Calvary Mater Newcastle, Waratah, NSW, 2298, Australia

    J. M. Martin MBChB, BSc, PhD, DMed, FRANZCR, GAustMS

  3. College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia

    J. M. Martin MBChB, BSc, PhD, DMed, FRANZCR, GAustMS, D. T. M Ngo B.Pharm, B.HealthSci (Hons), PhD & A. L. Sverdlov MBBS, PhD, FRACP

  4. GenesisCare, Buildings 1&11, The Mill, 41-43 Bourke Road, Alexandria, NSW, 2015, Australia

    D. A. Cehic MBBS, MBA, GAICD, FRACP

  5. Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia

    D. T. M Ngo B.Pharm, B.HealthSci (Hons), PhD & A. L. Sverdlov MBBS, PhD, FRACP

  6. Hunter Cancer Research Alliance, Waratah, NSW, 2298, Australia

    D. T. M Ngo B.Pharm, B.HealthSci (Hons), PhD & A. L. Sverdlov MBBS, PhD, FRACP

  7. Hunter New England Local Health District, Newcastle, NSW, 2305, Australia

    A. L. Sverdlov MBBS, PhD, FRACP

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  1. P. Ell BAppSc(MRS)NucMed, MBBS, GradCertClinEpi, FRANZCR
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  2. J. M. Martin MBChB, BSc, PhD, DMed, FRANZCR, GAustMS
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  3. D. A. Cehic MBBS, MBA, GAICD, FRACP
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  5. A. L. Sverdlov MBBS, PhD, FRACP
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Correspondence to A. L. Sverdlov MBBS, PhD, FRACP.

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Conflict of Interest

Philippa Ell declares that she has no conflict of interest. Jarad Martin is a contractor and shareholder for GenesisCare. Daniel A. Cehic declares that he has no conflict of interest. Doan T.M. Ngo declares that she has no conflict of interest. Aaron L. Sverdlov has received an equipment loan for research support from Roche Diagnostics Pty Ltd., an unrestricted educational grant from Celgene Pty Ltd., and a conference sponsorship grant from Bristol-Myers Squibb Australia Pty Ltd.

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Ell, P., Martin, J.M., Cehic, D.A. et al. Cardiotoxicity of Radiation Therapy: Mechanisms, Management, and Mitigation. Curr. Treat. Options in Oncol. 22, 70 (2021). https://doi.org/10.1007/s11864-021-00868-7

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