Breast Cancer Radiotherapy-induced Cardiotoxicity

In the multimodality treatment of breast cancer, adjuvant radiotherapy (RT) has an important role in achieving local control and increasing survival. Cardiac toxicity due to breast RT, especially left-sided breast RT, is rare but clearly recognizable. As overall survival rates are steadily increasing, long-term toxicities also become increasingly important in terms of late cardiac events, possibly caused by RT. Even small doses for the heart are thought to increase the risk of cardiac toxicity. Advanced radiation techniques such as intensity-modulated radiation therapy, volumetric-modulated arc RT, deep inspiration breath-hold techniques, and prone positioning for pendular breast can eliminate the heart from the primary beams. In addition to mean heart dose, breast cancer RT planning should also include constraints for cardiac subvolumes. Especially for patients who have pre-existing such as cardiovascular disease, diabetes mellitus, dyslipidemia, arterial hypertension, lifestyle factor (tobacco smoking, alcohol, physical inactivity, and poor nutrition), and physicians have to be careful about cardiotoxicity. Radiation oncologists and cardiology specialists should provide closely cooperating regular and long-term followup. This will provide the improvement of patient outcomes.