Prevention PRIOR TO Initiation of Therapy
Recommendation 2.1
➤ Avoid or minimize the use of potentially cardiotoxic therapies if established
alternatives exist that would not compromise cancer-specific outcomes.
(Strong Recommendation; CB-B).
Recommendation 2.2
➤ Clinicians should perform a comprehensive assessment in cancer
patients that includes a history and physical examination, screening for
cardiovascular disease risk factors (hypertension, diabetes, dyslipidemia,
obesity, smoking), and an echocardiogram prior to initiation of potentially
cardiotoxic therapies. (Strong Recommendation; EB/CB-B-H)
Prevention DURING Potentially Cardiotoxic Cancer Therapy
Recommendation 3.1
➤ Clinicians should screen for and actively manage modifiable
cardiovascular risk factors (smoking, hypertension, diabetes,
dyslipidemia, obesity) in all patients receiving potentially cardiotoxic
treatments. (Moderate Recommendation; IC/EB-B-Ins)
Recommendation 3.2
➤ Clinicians may incorporate a number of strategies, including use of
the cardioprotectant dexrazoxane, or continuous infusion, or liposomal
formulation of doxorubicin for prevention of cardiotoxicity in patients
planning to receive high-dose (e.g. ≥250 mg/m
2
doxorubicin, ≥600 mg/m
2
epirubicin) anthracyclines. (Moderate Recommendation; EB-B-I)
Recommendation 3.3
➤ For patients who require mediastinal RT which might impact cardiac
function, clinicians should select lower radiation doses when clinically
appropriate, and use more precise or tailored radiation fields with
exclusion of as much of the heart as possible. (Strong Recommendation;
EB/IC-B-I)
These goals can be accomplished through use of advanced techniques
including:
• Deep inspiration breath-holding for patients with mediastinal tumors or breast cancer
in which the heart might be exposed.
• Intensity-modulated radiation therapy that varies the radiation energ y while treatment
is delivered in order to precisely contour the desired radiation distribution and avoid
normal tissues.
Prevention
