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. 2024 Dec;19(12):1654-1667.
doi: 10.1016/j.jtho.2024.09.1433. Epub 2024 Sep 21.

American Radium Society Appropriate Use Criteria on Cardiac Toxicity Prevention and Management After Thoracic Radiotherapy

Arya Amini  1 , Vlad G Zaha  2 , Eman Hamad  3 , Pamela K Woodard  4 , Andreas Rimner  5 , Joe Y Chang  6 , Stephen G Chun  6 , Jessica Donington  7 , Martin J Edelman  8 , Matthew A Gubens  9 , Kristin A Higgins  10 , Puneeth Iyengar  11 , Aditya Juloori  7 , Benjamin Movsas  12 , Matthew S Ning  6 , Henry S Park  13 , George Rodrigues  14 , Andrea Wolf  15 , Charles B Simone 2nd  16
Affiliations

American Radium Society Appropriate Use Criteria on Cardiac Toxicity Prevention and Management After Thoracic Radiotherapy

Arya Amini et al. J Thorac Oncol. 2024 Dec.

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.

Keywords: Cardiac morbidity; Cardiac mortality; Cardiac screening; Cardiac toxicity; Lung cancer; Radiation induced heart disease.

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Conflict of interest statement

Disclosure All panelists were required to declare all conflicts of interest for the previous 36 months before initiating work on this document. These complete disclosure forms are retained by the American Radium Society in perpetuity. The American Radium Society Appropriate Use Criteria Steering Committee reviewed these disclosures with the chair and co-chair of this document and approved participation of the panelists before starting development of this work.

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