Radiation treatment is an established modality for patients with lung malignancy. However, the risk of side effects, including potential cardiopulmonary toxicity, remain an area of concern. Maximising radiation dose to the tumour, while minimising potential toxicities, requires careful consideration in radiation planning.
The risk for developing cardiopulmonary toxicity is multifactorial. In addition to the doses received by the heart and lungs, contributing factors include a patient’s baseline comorbidities, and the impact of other multimodal cancer treatments, including chemotherapy and immunotherapy. While radiation dose-relationships for pulmonary toxicity, such as pneumonitis risk, has been investigated over the years, the cardiac effect of radiation in lung cancer radiotherapy is an area of ongoing research, gaining traction more recently. The growing interest in cardiac toxicity, once thought to be a long-term side effect and of lesser importance in lung cancer, is due the combination of improved survival, the recognition of potential early onset in the weeks-months post treatment, as well as elevated baseline risk factors in this cohort of patients. While whole heart radiation dose had traditionally been the focus in earlier studies and utilised for dose limits clinically, there has been a shift to investigating cardiac substructure radiosensitivity, and their complex inter-relationships within the heart.
This session will provide an overview of the current evidence for radiation-related cardiopulmonary toxicity, discuss evolving radiation techniques and other strategies in reducing cardiorespiratory side effects, as well as areas for future research. The management of cardiopulmonary risk is an ongoing multidisciplinary collaborative effort, to ensure better patient outcomes and quality of life.