Radiation Therapy and Cardio-Oncology

Our guest today is Dr. Daniel Cehic, he is an electrophysiologist by training and is currently the chief medical officer at GenesisCare. He trained at the University of Adelaide, Royal Adelaide Hospital, and John Radcliffe Hospital in Oxford, England. He has established CardioOncology clinics in Adelaide and Sydney managing a variety of cardiac complications of cancer therapies and supervising the commencement of similar clinics in other states where GenesisCare has a cardiology presence. He is also the president of ICOS local chapter in Australia. He is interviewed by Felicity Nelson who is a freelance science and health editor based in Sydney, Australia.  The topic today is discussing radiation therapy and its negative effects on cardiovascular health. You can find the original recording here: https://medicalrepublic.com.au/heart-problems-a-bump-in-the-road-for-remission/55584 Pearls 1. Cardio-oncology is an emerging discipline focused on the prevention, early detection, and optimal treatment of CV disease in patients treated for cancer.1 2. Our understanding of the impact of radiation therapy on cardiovascular health has changed and the impact can start as soon as radiation therapy starts as early as 2 years and up to 40 years later.2,3 3. The impact of radiation therapy on cardiovascular health is linear, and dose-dependent but no dose threshold is required to have an impact on cardiovascular health.2,4 4. Radiotherapy increases the risk of cardiovascular events by about 10% but it is also dependent on other patients’ comorbidities such as hypertension, diabetes, and hyperlipidemia.4 5. Raising awareness about the importance of integrating cardio-oncology in cancer care is crucial as a recent international survey showed that only 45.8% of oncologists believed that cardio-oncology clinics would significantly improve cancer patients’ prognosis and 50% reported that cardiologists should be involved only when patients develop cardiotoxicity.5 6. Based on the most recent ICOS/ESC consensus statement, It is recommended that any patients who would receive cardiotoxic chemotherapy or radiotherapy to the chest should get a baseline ECG and Echo.6 References 1. Hayek, Salim & Ky, Bonnie. (2019). Preparing the Cardiovascular Workforce to Care for Oncology Patients: JACC Review Topic of the Week. Journal of the American College of Cardiology. 73. 2226-2235. 2. Bergom C, Bradley JA, Ng AK, et al. Past, Present, and Future of Radiation-Induced Cardiotoxicity: Refinements in Targeting, Surveillance, and Risk Stratification. JACC CardioOncol. 2021;3(3):343-359. Published 2021 Sep 21. 3. Wang K, Deal AM, et al. Cardiac Toxicity After Radiotherapy for Stage III Non-Small-Cell Lung Cancer: Pooled Analysis of Dose-Escalation Trials Delivering 70 to 90 Gy. J Clin Oncol. 2017;35(13):1387-1394. 4. Belzile-Dugas E, Eisenberg MJ. Radiation-Induced Cardiovascular Disease: Review of an Underrecognized Pathology. J Am Heart Assoc. 2021;10(18): e021686. 5. Peng J, Rushton M, Johnson C, et al. An international survey of healthcare providers' knowledge of cardiac complications of cancer treatments. Cardiooncology. 2019;5:12. Published 2019 Sep 2. 6. Curigliano G, Lenihan D, Fradley M, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020;31(2):171-190. doi:10.1016/j.annonc.2019.10.023 Alana de Quadros Schroeder, MDHospital Cardiologist Hospital Moinhos de Vento Cardiology Department