Breast Radiotherapy-Related Cardiotoxicity. When, How, Why. Risk Prevention and Control Strategies

Simple Summary Given that the majority of breast cancer patients receive adjuvant radiation therapy and/or systemic treatments that can enhance cardiovascular risk, it is imperative to consider a multidisciplinary approach to cardiovascular care and to develop strategies to identify and prevent radiation-associated cardiotoxicity. In this review, we seek to analyze the evidence of the mechanisms underlying cardiac damage secondary to breast irradiation, the impact of factors related to the patient herself, and the treatments administered, as well as to describe different strategies for reducing risks and managing radiation-induced heart disease if it has already occurred. All this with the aim of improving not only survival but also the quality of life for our patients. In recent decades, improvements in breast cancer management have increased overall patient survival; however, many cancer therapies have been linked to an important risk of cardiovascular adverse events. Cardio-oncology has been proposed as an emerging specialty to coordinate preventive strategies that improve the cardiovascular health of oncologic patients. It employs the most suitable personalized multidisciplinary management approach for each patient to optimize their cardiovascular health and improve their survival and quality of life. Radiotherapy is an essential part of the therapeutic regimen in breast cancer patients but can also increase the risk of cardiovascular disease. Therefore, minimizing the negative impact of radiation therapy is an important challenge for radiotherapy oncologists and cardiologists specializing in this field. The aim of the present review is to update our knowledge about radiation-induced cardiotoxicity in breast cancer patients by undertaking a critical review of the relevant literature to determine risk prevention and control strategies currently available.