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Cardiac mortality due to RT +/- smoking
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7% increased risk on cardiac events per 1 Gy increase in mean heart dose
→
ALARA (As Low As Reasonably Achievable)!
•
Higher risk in patients treated with systemic therapy, e.g. chemotherapy,
trastuzumab
•
Cardiac risks can differ due to:
- pre-existing cardiac disease
- comorbidity (diabetes, hypertension, hypercholesterolaemia)
- older age
- family history of cardiac disease
- lifestyle (smoking, obesity)
Darby NEJM 2013, Taylor Clinical Oncol 2015, Barlett Clin Oncol 2013, Taylor JCO 2017