Cardiovascular Manifestations From Therapeutic Radiation: A Multidisciplinary Expert Consensus Statement From the International Cardio-Oncology Society

• Published in: JACC CardioOncology Vol. 3; no. 3; pp. 360 - 380
• Main Authors: Mitchell, Joshua D, Cehic, Daniel A, Morgia, Marita, Bergom, Carmen, Toohey, Joanne, Guerrero, Patricia A, Ferencik, Maros, Kikuchi, Robin, Carver, Joseph R, Zaha, Vlad G, Alvarez-Cardona, Jose A, Szmit, Sebastian, Daniele, Andrés J, Lopez-Mattei, Juan, Zhang, Lili, Herrmann, Jörg, Nohria, Anju, Lenihan, Daniel J, Dent, Susan F
• Format: Journal Article
• Language: English
• Published: United States Elsevier 01-09-2021
• Subjects: Mini-Focus Issue: Radiation and Cardiovascular Disease; CI, confidence interval; SAVR, surgical aortic valve replacement; screening; TAVR, transcatheter aortic valve replacement; SVC, superior vena cava; CT, computed tomography; LIMA, left internal mammary artery; RT, radiation therapy; HF, heart failure; NT-proBNP, N-terminal pro–B-type natriuretic peptide; prevention; cardiovascular disease; CAC, coronary artery calcium; aHR, adjusted hazard ratio; TTE, transthoracic echocardiogram; HNC, head and neck cancer; HR, hazard ratio; PAD, peripheral arterial disease; OR, odds ratio; CAD, coronary artery disease; imaging; CTCA, computed tomography coronary angiography; MRI, magnetic resonance imaging; CABG, coronary artery bypass graft; CV, cardiovascular; DIBH, deep inspiratory breath hold; radiation therapy; cancer; HL, Hodgkin lymphoma
• ISSN: 2666-0873
• DOI: 10.1016/j.jaccao.2021.06.003

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.