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Research: cancer treatment may increase heart risks: Cleveland Clinic study finds that cancer survivors who had chest radiation therapy may face higher risks after having major heart surgery.

A new study from Cleveland Clinic finds that chest radiation used to shrink or kill breast cancer, Hodgkin's lymphoma and other cancers may increase the risk of developing heart disease in cancer survivors. And the risk can be elevated for decades after the radiation treatment.

The study, published in the American can Heart Association journal Circulation, also found that cancer survivors who had chest radiation face nearly double the odds of dying in the years after major heart surgery, compared with with similar patients who did not have radiation.

"While radiation treatments done on children and adults in the late 1960s, '70s and '80s played an important role in cancer survival, the treatment often takes a toll on the heart," says study author Milind Desai, MD, a cardiologist in Cleveland Clinic's Section of Cardiovascular Imaging. "Survivors are at greater risk than people who do not have radiation to develop progressive coronary artery disease, aggressive valvular disease, as well as pericardial diseases, which affect the heart's surrounding structures. These conditions often require major cardiac surgery.

Study details

In the study, researchers reviewed the files of 173 patients who had radiation treatment for cancer an average of 18 years before needing heart surgery. Study participants were then followed for an average of 7.6 years. These patients were then compared to 305 patients undergoing similar heart surgeries who didn't have radiation therapy.

Dr. Desai notes that patients within the two groups had similar pre-surgical risk scores, which are used to help predict how patients will fare after the operations.

Expectations and options

"These findings tell us that if you had radiation, your likelihood of dying after major cardiac surgery is high," Dr. Desai says. "That's despite going into the surgery with a relatively low risk score. In patients who have had prior thoracic radiation, we need to develop better strategies of identifying appropriate patients that would benefit from surgical intervention. Alternatively, some patients might be better suited for percutaneous procedures."

Percutaneous interventions are those that are done with through a small incision, including catheter procedures and some robotic heart procedures. These differ significantly from procedures that are done with open surgery in terms of impact on the heart.

Dr. Desai recommends patients discuss surgical options with their doctors when it comes to procedures such as heart valve repairs. You should also be sure to share your medical history, including treatments such as chest radiation, with your doctor as you two make treatment plans.

While the findings of the study are grim, Dr. Desai notes that the risks observed in his study may be diminishing.

"There are ways to address and minimize the risk of developing radiation heart disease," he says. "The good news is that with the evolution of radiation oncology techniques, they have started doing more targeted radiation, shielding other areas and reducing the dose to as little as possible to be effective."

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Title Annotation:WARNINGS
Publication:Heart Advisor
Date:Jun 1, 2013
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