Narrative review—cardiovascular evaluation before radiotherapy for patients with breast cancer and other malignancies

Objective: To raise awareness of possible cardiovascular risks among cancer survivors who received radiotherapy and to establish appropriate platforms for screening and monitoring the cardiovascular condition of these patients. Background: With advances in anti-cancer therapies, an increasing number of cancer patients are surviving for longer after the diagnosis and treatment. However, cancer therapy-associated cardiovascular complications can exacerbate mortality and morbidity. To note, radiation-induced cardiovascular diseases (RICVDs) cause deleterious effects on the heart, especially among survivors of breast cancer or malignancies in the chest cavity. Methods: Through literature searches, we observed a wide range of cardiovascular complications including heart failure, arrhythmia, valvular and ischemic heart diseases which have been reported depending on the cancer type and therapy. Among different types of malignancies, breast cancer, lung cancer, esophageal cancer and lymphoma may require direct radiotherapy to the heart. Despite a slow clinical course, radiation-related myocardial and vascular damage continuously accumulate. Instead of a rescue strategy, a comprehensive cardiovascular evaluation beforehand may be crucial to prevent the occurrence of cardiovascular complications. Conclusions: In this review article, we highlighted the importance of cardiovascular evaluation before radiotherapy for patients with breast cancer or other malignancy. Nevertheless, large-scale randomized control studies are crucial for establishing a clinical consensus.