ABSTRACT

Radiation therapy is an important component in the treatment of cancer. It may play a role as an adjuvant, neoadjuvant, palliative, or definitive therapy, with or without concurrent chemotherapy. Radiation is most commonly delivered as a local/regional treatment by an external beam consisting of photons, electrons, protons, or heavy particles but may also be delivered via brachytherapy (where a sealed radiation source is placed adjacent to the target) or systemically via unsealed sources. The side effects of radiation therapy are a function of the tissues included in the radiation field. Treatment of diseases within the thoracic region, such as Hodgkin lymphoma, lung, and breast cancer, carries the risk of radiation-induced cardiovascular toxicity (RICT).

Side effects of therapeutic radiation to the heart and coronary vessels include pericarditis, coronary artery disease (CAD), arrhythmias, cardiomyopathy, valvular dysfunction, and heart failure. Pericarditis and pericardial effusions are potential short-term toxicities that may occur during or within the weeks following treatment. Long-term side effects may present in the months to years after radiation therapy, possibly as late as 20 years or more post-treatment. Late toxicities include CAD, valvular heart disease, and heart failure.

Major risk factors that increase the likelihood of RICT include higher radiation doses, adjuvant treatment with cardiotoxic chemotherapy, irradiation of the left side of the thorax, and the presence of pre-existing cardiovascular disease. Studies have correlated the mean dose of radiation received by various heart sub-structures to the incidence of major adverse cardiac events (MACE), such as hospitalization for heart failure, myocardial infarction, and even cardiac death. Given the importance of radiation therapy in treating cancer and the high prevalence of cardiovascular disease in Western populations, numerous preventive measures have been suggested and used in clinical practice, such as dose limitation, proton and particle therapy, conformal radiation therapy, and deep-inspiration breath-hold technique.

PMID:32119340 | Bookshelf:NBK554453

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PubMed articles on: Cancer & VTE/PE

Direct Oral Anticoagulants for Cancer-Associated Venous Thromboembolism

Curr Oncol Rep. 2023 Jun 6. doi: 10.1007/s11912-023-01428-y. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: To present the randomized controlled trial (RCT) evidence and highlight the areas of uncertainty regarding direct oral anticoagulants (DOAC) for cancer-associated venous thromboembolism (CAT).

RECENT FINDINGS: In the last years, four RCTs have shown that rivaroxaban, edoxaban, and apixaban are at least as effective as low-molecular-weight heparin (LMWH) for the treatment of both incidental and symptomatic CAT. On the other hand, these drugs increase the risk of major gastrointestinal bleeding in patients with cancer at this site. Another two RCTs have demonstrated that apixaban and rivaroxaban also prevent CAT in subjects at intermediate-to-high risk commencing chemotherapy, albeit at the price of higher likelihood of bleeding. By contrast, data are limited about the use DOAC in individuals with intracranial tumors or concomitant thrombocytopenia. It is also possible that some anticancer agents heighten the effects of DOAC via pharmacokinetic interactions, up to making their effectiveness-safety profile unfavorable. Leveraging the results of the aforementioned RCTS, current guidelines recommend DOAC as the anticoagulants of choice for CAT treatment and, in selected cases, prevention. However, the benefit of DOAC is less defined in specific patient subgroups, in which the choice of DOAC over LMWH should be carefully pondered.

PMID:37278934 | DOI:10.1007/s11912-023-01428-y

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PubMed articles on: Cancer & VTE/PE

Risk of Venous Thromboembolism in Multiple Myeloma Patients During the Immediate Peri-Autologous Hematopoietic Cell Transplantation Phase

Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231177678. doi: 10.1177/10760296231177678.

ABSTRACT

Venous thromboembolism (VTE) is a serious complication commonly experienced in cancer patients. Incidence of VTE typically brings poor prognosis as it represents the second most common cause of mortality in cancer patients just after the malignancy itself. Studies suggest that multiple myeloma (MM) is among the malignancies with further enhanced risk of VTE, especially in patients undergoing autologous hematopoietic cell transplantation (AHCT). However, risk factors and preventative approaches remain poorly explored. Here, we explore the incidence of VTE in MM patients undergoing AHCT, while also highlighting risk factors and preventions that may aid in preventing VTE in patients who are at higher risk.

PMID:37277999 | DOI:10.1177/10760296231177678

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PubMed articles on: Cancer & VTE/PE

Cerebral infarction and in-hospital mortality for patients admitted to hospital with intracardiac thrombus: insights from the National Inpatient Sample

J Thromb Thrombolysis. 2023 Jun 5. doi: 10.1007/s11239-023-02824-8. Online ahead of print.