Clinical & Experimental Cardiology
Open Access

Abstract

Radiotherapy-Chemotherapy Related Heart Diseases in Surgical Setting

Fabio Maramao, Fabio Stefano Maramao and Ysabel Conde

Introduction: The numbers of healed or long term survivor’s cancer patients are increasing. Radiotherapy and chemotherapy can induce heart damages even after many years. Cancer patient is a chronic patient and frequently requires prolonged anti-cancer therapies and repeated interventions of oncologic surgery during the course of his disease.
According to Guideline on “Perioperative Cardiovascular Evaluation and Management of Patients Undergoing non-cardiac Surgery”, the perioperative cardiologic management can determine changes that can take time and that can include the decision to change medical therapies, the decision to perform further cardiovascular interventions or the decision to recommend alternative therapeutic strategies. The consequent delay of the planned surgery to allow the assessment and significant changes in cardiologic management, will negatively affect outcome also with a negative impact on the costs for the time extension of the hospitalization.
Case report: We present a male caucasian patient of 51 years, smoker, hypertensive, with an history of resection of the right lung for lung microcytoma at age 27 years, treated with chemotherapy and radiotherapy (1988). He was admitted (2012) into our Institute to undergo total surgical laryngectomy for laryngeal cancer. At the perioperative cardiovascular assessment for non-cardiac surgery we found a total atrio-ventricular block and triple vessel coronary artery disease. The planned surgery was delayed, a dual-chamber pacemaker was implanted and the patient underwent surgical myocardial revascularization with triple coronary artery bypass grafting. Consequently, according to the decision of surgeons and oncologists the patient underwent radiation therapy instead of laryngeal surgery.
Conclusion: In cancer patients we recommend the cardiologic surveillance, also for several years, after radiotherapy and chemotherapy to detect and treat in time heart damages. This appears clinically and economically cost-effective because it can reduce the hospitalization time in surgical setting for oncologic time-sensitive procedures.