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Radiation, Chemoimmunotherapy and Your Heart

As a clinical oncologist and radiotherapist, I am indeed privileged to be working in a multi-disciplinary hospital that is well-supported by various clinical specialties.

Even though cancer rarely originates from the heart, advanced cancers often spread to the heart lining (pericardium) and result in fluid collection surrounding the heart, which is also known as pericardial effusion. This will affect the normal heart pumping mechanism and lead to abnormal heart rhythm.

In cases like these, patients will see a cardiologist and/or cardiothoracic surgeon for drainage of the fluid collection to restore normal heart function and rhythm.

Anthracycline, also known as the red ruby, is a very effective chemotherapeutic agent particularly against lymphoma, breast cancer and bone sarcoma. Prior to the administration of red ruby chemotherapy, patients will require screening with ECG. Red ruby should be avoided in patients with pre-existing heart disease.

Breast cancer is not a single disease. Scientists have discovered various subtypes of breast cancer. HER2-driven breast cancer, an aggressive subtype, is caused by overexpression of HER2 cancer gene. Trastuzumab is a monoclonal antibody against HER2 cancer gene. It works by blocking the HER2 receptor and preventing the growth of HER2 breast cancer.

Trastuzumab reduces the risk of breast cancer recurrence by 30% and doubles the chance of survival for patients with advance disease. However trastuzumab may potentially affect the heart’s left-sided chamber function. Thus, patients require close monitoring with echocardiogram.

Heart is located in the central part of the chest (known as mediastinum), between the right lung and the left lung. Anatomically and physiologically, heart and lungs are closely interrelated. Globally, lung cancer is the most common cancer in males and females combined. It affects both smokers (current and ex-smokers) and non-smokers.

Lung cancers are treated with molecular targeted therapy, immunotherapy, chemotherapy and radiotherapy according to disease subtypes and stage. Cases of radiation-induced cardiac damage have been reported with the use of older radiotherapy delivery technique.

Volumetric-modulated arc therapy (VMAT) is the latest radiotherapy technique that allows accurate delivery of radiation to the tumour, while minimising the dose to the heart. Thereby, the heart can be spared from unnecessary exposure to radiation and its normal function can be well-preserved.

Working in a multi-disciplinary setting offers me the opportunity to collaborate with my colleagues to deliver the most optimal care to my patients. Our weekly multi-disciplinary meetings provide a platform to discuss challenging cases that requires input from various specialties. 

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