Contemporary Understandings of Cardiovascular Disease After Cancer Radiotherapy: a Focus on Ischemic Heart Disease
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MANAGEMENT OF ACUTE CORONARY SYNDROMES (H JNEID, SECTION EDITOR)
Contemporary Understandings of Cardiovascular Disease After Cancer Radiotherapy: a Focus on Ischemic Heart Disease Lisa Kim 1 & Emefah C. Loccoh 2 & Reynaldo Sanchez 1 & Patrick Ruz 1 & Uzoma Anaba 1 & Terence M. Williams 2 & Jeremy Slivnick 1 & Ajay Vallakati 1 & Ragavendra Baliga 1 & Ahmet Ayan 2 & Eric D. Miller 2 & Daniel Addison 1,3,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Radiation-induced cardiovascular disease, including coronary artery disease, is a well-known sequela of radiation therapy and represents a significant source of morbidity and mortality for cancer survivors. This review examines current literature and guidelines to care for this growing population of cancer survivors. Recent Findings The development of radiation-induced ischemic heart disease following radiation can lead even to early cardiotoxicities, inclusive of coronary artery disease, which limit cancer treatment outcomes. These coronary lesions tend to be diffuse, complex, and proximal. Early detection with multimodality imaging and targeted intervention is required to minimize these risks. Summary Early awareness, detection, and management of radiation-induced cardiovascular disease are paramount as cancer survivorship continues to grow. Keywords Radiotherapy . Ischemic disease . Cardio-oncology . Thoracic malignancies . Cardiac imaging . Lung cancer
Introduction Over the past few decades, there has been a surge in novel anticancer therapeutic strategies, inclusive of updated radiation delivery and dosing strategies, leading to improved cancer survival [1]. With this growing population of survivors, however, cardiovascular disease (CVD) has become a leading Lisa Kim, Emefah C. Loccoh and Eric D. Miller contributed equally to this work. This article is part of the Topical Collection on Management of Acute Coronary Syndromes * Daniel Addison [email protected] 1
Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
2
Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
3
Division of Cancer Control and Prevention, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus, OH, USA
4
Division of Cardiology, The Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, 473 W. 12th Ave., Columbus, OH 43210, USA
cause of post-treatment morbidity and mortality, particularly among those treated with mediastinal radiation [2, 3]. Emerging emphasis has been placed on characterizing radiation-associated ischemic heart disease and myocardial infarction (MI) in order to mitigate these risks. Traditionally, radiation-associated cardiotoxicities have included pericardial disease, congestive heart failure, valvular heart disease, conduction system disease, vasculopathy, and ischemic heart disease [4, 5]. Within this review, we will discuss these mod
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