Oncology and the heart
Given our chemotherapy, radiation therapy, and the advent of immune checkpoint inhibitors, oncology and cardiology may be more closely linked than ever before. This interview reviews the potential toxicities of today's radiation, chemotherapy, immunotherapy, and the structural involvement that tumors may cause in and around the heart. Although the immune checkpoint inhibitors are not commonly associated with cardiac toxicity, their increasing use may tell us otherwise. This interview summarizes the close association between oncology and cardiology, which we should bear in mind as we treat our patients.
Correspondence David H Henry, MD; David.Henry@uphs.upenn.edu.
Disclosures The authors report no disclosures/conflicts of interest.
Citation JCSO 2017;15(3):e178-e182
©2017 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0348
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DH They’re so much better now, so this is less common.
JC With the shielding and breath-holding techniques and position changes, doing upright radiation rather than supine, and because the technology has improved both in the delivery of radiation and the technology in understanding where all the radiation is going, in today’s world, we can calculate pretty precisely how much radiation the heart actually receives. Ultimately, with the protective mechanisms that are in place going forward, the risks that I described for that survivor are probably exponentially less than what’s reported in the literature and what we see clinically. Radiation has become much, much safer. There is still probably some small risk of development of late changes, but I don’t think we know what that risk is today because the shielding and things we do to protect the heart have not yet been studied in the long term.
DH Of course, the patient is breathing and there’ll be some movement of the target. Some of the radiation techniques can follow the target despite the breathing?
JC Yes, definitely true. Radiation delivery is much more precise today. Not only has the delivery changed, but so has what we know about the location of potential arterial disease. For example, if you read any textbook, it says that for the coronaries, that it’s ostial and proximal disease of the left main, or the left anterior descending, or the right coronary artery. Today, somebody who gets chest/mediastinal radiation, for either breast cancer, lymphoma, or for a mediastinal tumor, the location of potential disease is more likely to mimic the location of classic coronary disease in the mid-portion of the left anterior descending artery rather than at the ostium. It’s going to be a different disease going forward.2,3
