Prevention and Management of Cardiotoxicity Secondary to Thoracic Radiation

Mediastinal radiation is an integral component of treatment of a variety of thoracic malignancies. Improvement in therapeutics and technology help us witness long term survivors, hence our focus is now cure along with quality of life. Heart being the central thoracic structure bears the major brunt of adverse effects following mediastinal radiation. These acute and chronic side effects combined are classified as RICT (radiation induced cardiotoxicity). A better understanding of the underlying pathophysiology is required to improve the screening protocols for identifying preclinical RICT and allow for earlier interventions. Although significant improvement in the techniques of radiation have reduced the incidence of these cardiac events. But still RICT remains a potentially significant toxicity for many patients with thoracic cancers. Improved knowledge about radiation doses limitations to cardiac substructures allows for better personalization of radiation in the times to come. Better application of cardiac contouring atlases in routine clinics and case management is required. Adapting to the protocols of reduced radiation field and dose together with vigorous attempts of using breath hold technique, prone positioning and the latest techniques of radiation along with aggressive cardiovascular risk modification can help in further reducing the incidence of radiation induced cardiac disease.