ESTRO 38 Abstract book

S306 ESTRO 38

mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol. 2005;6(8):557-65. 3. Cuculich PS, Robinson CG. Noninvasive Ablation of Ventricular Tachycardia. N Engl J Med. 2018;378(17):1651- 2 4. Jumeau R, Ozsahin M, Schwitter J, Vallet V, Duclos F, Zeverino M, et al. Rescue procedure for an electrical storm using robotic non-invasive cardiac radio-ablation. Radiother Oncol. 2018;128(2):189-91. SP-0585 Managing cardiotoxicity in oncology follow up and primary care services S. Faithfull 1 1 University of Surrey, Faculty of Health and Medical Sciences, Guildford, United Kingdom Abstract text The purpose of this paper is to explore how primary care and oncology can work together to identify those at risk of cancer related cardiovascular disease (CVD) to provide primary and secondary prevention. Cancer therapeutic agents impact directly on the coronary endothelium, myocardium, heart valves and other structures and the increase in multi-modality treatment with radiotherapy means more patients are likely to be affected in the future. Many of the factors associated with increased prevalence of cancer are also associated with cardiovascular disease for example, ageing, low physical activity, smoking and obesity. Cancer treatment cardiac damage is more responsive to therapy if treated early, so this paper focuses on how as clinical oncologists, nurses and therapy radiographers we can work more closely with primary care to promote earlier diagnosis of cardiac toxicity and instigate protocols for monitoring heart health in those at higher risk during radiotherapy follow- up. Improving cardio-toxicity management requires primary prevention before treatment starts, to reduce the likelihood of a cardiac events after cancer treatment, by active risk reduction [1]. Evaluation of coronary risk primarily by means of screening for elevated cholesterol, diabetes, hypertension, diabetes, smoking and family history can identify patient’s CVD risk profiles. CVD risk reduction should be considered prior to cancer therapy, promoting lifestyle advice and cardio protective measures. Secondary prevention is also important in treating cardiac dysfunction especially in patients at higher risk. Heart failure treatment within 3 months of symptom development is reversible >90% over 2 years whilst after 6 months’ post symptom development management is less effective [2]. Furthermore, in cancer surveillance and follow up, unexpected changes in patients existing CVD should be investigated and that these symptoms may be early signs of cardio toxicity. Primary care services are involved in managing the long-term health of people with cancer as well as holistically their long-term conditions (LTC). More than 40% of cancer patients have one and 15% two LTC. However primary care physicians have limited knowledge of cancer therapies and how these may destabilise previously well controlled cardiovascular disease and diabetes [3]. In recent surveys, primary care physicians, oncology nurses and allied health professionals undertaking follow up of cancer patients were unaware of cardiac toxicity or how best to identify or manage symptoms [4]. Clear reporting and assessment communication between cancer centres and primary care services with potential side-effects listed, risk of occurrence, cumulative dose and referral guidance if symptoms occur should be provided. 1.Zamorano L, Lancellotti P et al, ESC Scientific Document Group; 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task

HEART Projects. An overview of these studies will be presented.

SP-0583 Practical aspects of estimating and measuring of CIED dose in radiotherapy procedures E. Konstanty 1 , B. Bak 2 , W. Szyszka 2 1 Greater Poland Cancer Centre, Department Of Medical Physics, Poznan, Poland ; 2 Greater Poland Cancer Centre, Radiotherapy Department Ii, Poznan, Poland Abstract text According to AAPM Report No. 45 “Management of radiation oncology patients with implanted cardiac pacemakers” cardiac pacemakers can fail from radiation damage and can exhibit functional changes. Total dose to each type of cardiovascular implantable electronic device (CIED) should be estimated for each patient who undergoes radiotherapy. One of the recommendations of the task group is to estimate the absorbed dose to be received by the device before treatment. Another important document that contains practical recommendations for specialists treating patients with CIEDs with radiation therapy is a clinical guideline of the Heart Rhythm Society: “2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices”. Maximum expected cumulative incident dose should be estimated and minimize (threshold of 5 Gy). In some cases national guidelines introduce the obligation to perform not only the estimation but also the measurement of CIED dose during radiotherapy session. In this presentation possible methods and technical difficulties of the CIED dose estimation and in-vivo dosimetry will be discussed. Finally, the results of in-vivo dosimetry of CIEDs treated in Greater Poland Cancer Centre will be presented. SP-0584 From biological basis of RI cardiac toxicity to the new application of SBRT in the cardiovascular field M. Vozenin 1 1 Centre Hospitalier Universitaire Vaudois, Department of Radiation Oncology, Lausanne Vaud, Switzerland Abstract text Cardiac toxicity induced by anti-cancer treatments including radiotherapy is today an issue for long-term cancer survivors 1 2 without therapeutic management. The first part of this talk will be dedicated to summarize biology-driven efforts made to develop translatable therapeutic approaches to prevent, mitigate or reverse radiation injury to the heart. Then, recent results will be shown including a yet never described gender difference in both radiation-induced sensitivity and sensitivity to combined treatment based upon RT, paclitaxel and herceptine. Female mice are protected from cardiac defect and this protection is mediated by small GTPase RhoB via its intereaction with ERa. In the second part, possible new application SBRT (Stereotactic body radiotherapy) in cardiology will be discussed such as the non-invasive management of ventricular tachycardia (VT) refractory to standard treatments 3,4 . In addition, first preclinical data will be shown that investigates the physiopathological impact of such large but localized dose of irradiation on the heart using experimental mouse model and Image guided radiotherapy device (XRad225CX-PXi) that enable to mimic clinical SBRT configuration. 1. Andratschke N, Maurer J, Molls M, Trott KR. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention. Radiother Oncol. 2011;100(2):160-6. 2. Darby SC, McGale P, Taylor CW, Peto R. Long-term