American Radium Society Appropriate Use Criteria on Cardiac Toxicity Prevention and Management After Thoracic Radiotherapy
Recommended Citation
Amini A, Zaha VG, Hamad E, Woodard PK, Rimner A, Chang JY, Chun SG, Donington J, Edelman MJ, Gubens MA, Higgins KA, Iyengar P, Juloori A, Movsas B, Ning MS, Park HS, Rodrigues G, Wolf A, and Simone CB, 2nd. American Radium Society™ Appropriate Use Criteria on Cardiac Toxicity Prevention and Management After Thoracic Radiotherapy. J Thorac Oncol 2024.
Document Type
Article
Publication Date
9-21-2024
Publication Title
J Thorac Oncol
Abstract
INTRODUCTION: The multidisciplinary American Radium Society Thoracic Committee was assigned to create appropriate use criteria on cardiac toxicity prevention and management for patients undergoing radiotherapy.
METHODS: A systematic review of the current literature was conducted. Case variants of patients with thoracic malignancies undergoing radiation were created based on presence or absence of cardiovascular risk factors and treatment-related risks assessed by dose exposure to the heart and cardiac substructures. Modified Delphi methodology was used to evaluate the variants and procedures, with less than or equal to three rating points from median defining agreement/consensus.
RESULTS: A total of six variants were evaluated. The panel felt that patients with cardiac comorbidities at high risk for radiation-related cardiac toxicity should undergo a prescreening cardiac-focused history and physical (H&P) examination, electrocardiogram, cardiac imaging including an echocardiogram, and referral to a cardiologist/cardio-oncologist. Recommendations for those without cardiac comorbidities at low risk for cardiac toxicity were to undergo a baseline H&P examination only. Conversely, those without cardiac comorbidities but at high risk for radiation-related cardiac toxicity were recommended to undergo a prescreening electrocardiogram, in addition to a H&P examination. For patients with cardiac comorbidities at low risk for cardiac toxicity, the panel felt that prescreening and postscreening tests may be appropriate.
CONCLUSIONS: The American Radium Society Thoracic appropriate use criteria panel has developed multidisciplinary consensus guidelines for cardiac toxicity prevention, surveillance, and management after thoracic radiotherapy based on cardiac comorbidities at presentation and risk of radiation-related cardiac toxicity.
PubMed ID
39313150
ePublication
ePub ahead of print
