Key result
Breast radiotherapy linked to increased heart disease risk, especially with left-sided tumors and anthracyclines.
Why the study?
With improved breast cancer survival, CV disease risk has increased due to multimodal treatments including radiotherapy, but evidence-based recommendations for screening, surveillance, and treatment remain lacking.
Does breast cancer irradiation increase the risk of cardiac toxic effects in breast cancer survivors?
Does breast cancer irradiation increase the risk of cardiac toxic effects in breast cancer survivors?
Breast cancer radiotherapy, particularly for left-sided tumors and when combined with anthracyclines, increases cardiovascular risk, highlighting the need for multidisciplinary management and cardioprevention strategies.
Heightens cardiotoxicity awareness in left-sided breast radiotherapy survivors, especially with anthracyclines; leaves open evidence-based screening guidelines.
IMPORTANCE: To promptly recognize and manage cardiovascular (CV) risk factors before, during, and after cancer treatment, decreasing the risk of cancer therapy-related cardiac dysfunction is crucial. After recent advances in breast cancer treatment, mortality rates from cancer have decreased, and the prevalence of survivors with a potentially higher CV disease risk has increased. Cardiovascular risks might be associated with the multimodal approach, including systemic therapies and breast radiotherapy (RT). OBSERVATIONS: The heart disease risk seems to be higher in patients with tumors in the left breast, when other classic CV risk factors are present, and when adjunctive anthracycline-based chemotherapy is administered, suggesting a synergistic association. Respiratory control as well as modern RT techniques and their possible further refinement may decrease the prevalence and severity of radiation-induced heart disease. Several pharmacological cardioprevention strategies for decreasing cardiac toxic effects have been identified in several guidelines. However, further research is needed to ascertain the feasibility of these strategies in routine practice. CONCLUSIONS AND RELEVANCE: This review found that evidence-based recommendations are lacking on the modalities for and intensity of heart disease screening, surveillance of patients after RT, and treatment of these patients. A multidisciplinary and multimodal approach is crucial to guide optimal management.
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Meattini et al. (2021) conducted a review in Breast cancer. Breast radiotherapy was evaluated. Breast radiotherapy, especially for left-sided tumors and with anthracyclines, is associated with increased heart disease risk, though evidence-based screening and surveillance guidelines are lacking.
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