Ask the Expert: The Impact of Cancer & Radiation Therapy on Heart Valve Function with Dr. Luis Castro
By Adam Pick on December 12, 2013
Since launching this website, I have met many patients who experience valvular disorders after radiation therapy for cancer. I was curious to learn more about the connection between cancer, radiation treatment and heart valve disease, so I contacted Dr. Luis Castro, a leading heart valve surgeon from Sequoia Hospital Heart & Vascular Institute in Redwood City, California.
Here are the highlights from our exchange:
Adam: Thanks so much for taking the time to chat with me today about heart valve disease related to cancer treatment – specifically radiation therapy. Do you see many patients with this issue?
Dr. Luis Castro: Thank you Adam for educating the patients at your website about this very important topic. To start this conversation, I have to say that we are so fortunate to be living in this time of modern medicine in which once incurable cancers and malignancies, that took the lives of so many young people, can now be cured. In particular, radiation therapy, aimed directly in high doses at the specific tumor, has become a lifesaver in treating and curing many types of cancers and lymphomas.
In the setting of radiation therapy, this miraculous heart of ours may be prone to injury. It is recognized that radiation therapy directly to the chest may, while life-saving, cause injuries to the heart that can show up many years following treatment. The high doses of radiation required to wipe out those cancer cells (responsible for future spread), may also injure the lining of the heart sac (or pericardium), the heart muscle itself, the aortic and mitral valves, coronary arteries and the electrical conduction system of the heart.
Adam: Are there any statistics about the incidence of cardiac issues resulting from radiation therapy for cancer?
Dr. Luis Castro: It is estimated to occur in at least 10% of those patients treated with radiation therapy to the chest. Typically, it begins to present itself from five years to several decades following treatment. Cancer specialists are working on modifying necessary radiation protocols to lessen heart injury without sacrificing success against cancer growth.
Adam: Ten percent seems pretty significant. Is this radiation side effect well understood by the medical community?
Dr. Luis Castro: Surprisingly, even amongst our cardiologists, this direct link of radiation therapy to heart disease is not well understood. For many patients, this can lead to misdiagnosis and under treatment. Awareness and knowledge that radiation treatment may create long term problems is the key to early diagnosis and successful treatment.
Adam: How can this situation impact your role as a surgeon?
Dr. Luis Castro: Depending on the heart structures affected by radiation, surgical procedures can be quite complex and, at times, riskier than a typical heart operation. If necessary, surgical procedures may include radical removal of the heart sac that may thicken and constrict the ability of the heart to fill and squeeze normally, complex valve replacement of the aortic and/or mitral valves that can densely calcify and stiffen, bypass procedures of the coronary arteries, and pacemaker implantation. These surgical procedures should be performed by surgeons experienced with radiation complications, as the extent of heart disease prior to operation is typically underestimated, and at the time of operation can be extremely complex and difficult to manage, even in the best of hands.
Adam: Do you have any advice for patients who have had radiation therapy and are now experiencing valve disorders — like stenosis?
Dr. Luis Castro: If you, or a loved one, has received radiation therapy to the chest for cancer treatment, I recommend echocardiographic evaluation of the heart five years after therapy. And then, life-time serial echocardiographic studies, as necessary, to follow any potential problems that may appear decades after receiving radiation.
Adam: Thanks so much for taking the time to help all of us learn more about the connection between cancer, radiation therapy and heart valve disease.
Dr. Luis Castro: Thank you!
Keep on tickin!