Cardiooncology - Cancer and Heart Diseases

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Sibel ÇATIRLI ENAR
İstanbul Altınbaş Üniversitesi Tıp Fakültesi, Kardiyoloji ABD, İstanbul, Türkiye
Article Language: TR
Değerli meslekdaşlarım,

Kardiyoonkoloji, kardiyolojide kanserli hastaların kardiyovasküler sağlığına odaklanan yeni bir alandır. Kardiyovasküler hastalıklar artık kanserden kurtulanlar arasında morbidite ve mortalitenin ana nedeni olarak kabul edilmektedir. Kardiyoonkoloji hastaları iki grup hastadan oluşur: a) Kanserden kurtulan ve kardiyovasküler hastalığa yakalanan grup ve b) kardiyovasküler hastalıktan kurtulan ve kansere yakalanan grup.

Gerek hematolojik ,gerekse onkolojik malignitelerin tedavisinde kullanılan kemoterapi, immünoterapi ve radyoterapi gibi modern tedavi yöntemlerinin başarısına paralel olarak, son yıllarda bu hastaların sağ kalımında önemli iyileşmeler elde edilmiştir. Sağ kalımda elde edilen bu başarı tedavi ilişkili kardiyotoksisiteyi de beraberinde getirmiştir. Kardiyotoksisitenin önlenmesi, erken tanınması veya tedavisi, kanser hastalarında tedavinin kesintiye uğramadan başarılı bir şekilde tamamlanması için hayati öneme sahiptir.

Kanser ve kardiyovasküler hastalıkların risk faktörleri mevcuttur. Aterosklerotik plak ve kanser gelişimi benzer mekanizmalarla oluşmaktadır. İnflamasyon her iki hastalığın gelişiminde de ortak fizyopatolojiyi oluşturmaktadır.

Kanser tedavisi ile ilişkili kalp yetersizliği: Kalp yetersizliği ile sonuçlanabilen kardiyotoksisite en korkulan komplikasyondur. Bu komplikasyon tedavi sırasında veya hemen sonra gelişebileceği gibi tedavi sonrası uzun dönemde de ortaya çıkabilir. Toksisite geri dönüşümlü olabilir veya olmayabilir.

Kardiyotoksisite belirlemede biyobelirteçlerin rolü: Biyobelirteçler, kardiyotoksisitenin erken belirlenmesi ve tedavinin kılavuzluğunda klinisyenlere yardımcı olabilirler. Kardiyotoksisitenin belirlenmesi ve monitörizasyonunda en çok çalışılan en önemli biyobelirteçler kardiyak troponinler ve natriüretik peptidlerdir.

Kardiyotoksisite belirlemede görüntüleme: Kardiyotoksik onkoloji alacak hastalarda görüntüleme kardiyovasküler risk degerlendirilmesi ve kardiyovasküler hastalıkların saptanmasında önemli bir araçtır. Tedavi başlangıcı ve tedavi sırasında görüntüleme mutlaka gereklidir.

Kanser ve koroner arter hastalıkları (KAH): Hem genel yaşam süresinin uzaması hem de onkoloji hastalarında sağkalımın artmasıyla giderek daha fazla KAH görülmektedir. Onkolojik tanısından önce hafif KAH olan hastalarda, KAH'ın hem bazı kanser tedavilerinin etkileri hem de kanserin kendisinin bir sonucu olarak ortaya çıkan proinflamatuar ve protrombotik ortama bağlı olarak daha hızlı ilerlediği görülmüştür. KAH olan kanser hastaları, kardiyologlar için verilerin az olduğu ve henüz kanıta dayalı kılavuzların olmadığı zorlu bir hasta grubudur.

Kanser tedavisi, vasküler toksisite ve hipertansiyon ilişkisi: Hipertansiyon, antineoplastik tedavi uygulanan hastalarda görülen en sık kardiyovasküler hastalıktır. Hem tedavi öncesi olan hem de tedavi yan etkisi olarak oluşan hipertansiyon, antineoplastik tedavinin kardiyovasküler yan etki oluşturma riskini artırmaktadır.

Kanser hastalarında miyokard ve perikard hastalıkları: Perikardit ve perikardiyal efüzyon, kanser hastalarında görülen en yaygın perikardiyal hastalık formlarıdır. Bağışıklık kontrol noktası inhibitörlerinin artan kullanımı nedeniyle miyokardit insidansı artmaktadır. Kanser hastalarında miyokardit ve perkardiyal hastalıklar, kardiyoloji ve onkoloji arasında multidisipliner bir yaklaşım gerektirmektedir.

Kanser hastalarında aritmiler ve antikoagülasyon: Kanser ve atriyal fibrilasyon (AF), ortak etiyoloji ve komorbiditeleri paylaşan hastalıklardır. Kanser hastalarında AF gelişme riski artmaktadır.. AF tedavisi kanser hastalarında oldukça zor olabilir, bunun nedeni kanserli hastalarda kemoterapi rejimleri ile antikoagülan ajanlar arasında ilaç etkileşim olasılığının var olmasıdır.

Radyoterapi (RT) ve kalp: RT kullanımı malignitelerde yaşam beklentilerinde iyileşmelere yol açmıştır. Ancak RT sonrası iyileşip sağ kalan hastaların takiplerinde ortaya çıkan yan etkiler mortalitede artışa neden olmaktadır. Özellikle torakal bölgeye uygulanan RT sonrası sağ kalan hastaların takiplerinde, kardiyovasküler sistem hastalıkları mortalitenin en önemli sebebi olarak ortaya çıkmaktadır. Günümüzde RT tekniklerindeki gelişmeler ve artan koruyucu önlemler sayesinde yan etkilerde azalmalar izlenmektedir.

Bu kitapta; hematolojik/onkolojik maligniteler ve kalp hastalıkları ilişkisi, kanser tedavisinin (kemoterapi, radyoterapi, immünoterapi) kardiyak yan etkileri, tanı ve tedavi yöntemleri ele alınmıştır. Bu iki hastalığın birarada bulunması multidisipliner bir yaklaşım gerektirmektedir. Meslektaşlarımıza yararlı olacağı düşünülerek hazırlanmıştır.

Prof. Dr. Sibel ÇATIRLI ENAR
Editör
Dear colleagues,

Cardiooncology is a new field in cardiology focusing on the cardiovascular health of patients with cancer. Cardiovascular diseases are now recognized as the main cause of morbidity and mortality among cancer survivors. Cardiooncology patients consist of two groups of patients: a) the group that survived cancer and had cardiovascular disease, and b) the group that survived cardiovascular disease and had cancer.

In parallel with the success of modern treatment methods such as chemotherapy, immunotherapy and radiotherapy used in the treatment of both hematological and oncological malignancies, significant improvements have been achieved in the survival of these patients in recent years. This success in survival has brought about treatmentrelated cardiotoxicity. The prevention, early diagnosis or treatment of cardiotoxicity is vital for the successful completion of treatment in cancer patients without interruption.

There are risk factors for cancer and cardiovascular diseases. Development of atherosclerotic plaque and cancer occurs with similar mechanisms. Inflammation constitutes a common pathophysiology in the development of both diseases.

Heart failure associated with cancer therapy: Cardiotoxicity, which may result in heart failure, is the most feared complication. This complication may occur during or immediately after treatment or in the long term after treatment. Toxicity may or may not be reversible.

The role of biomarkers in determining cardiotoxicity: Biomarkers can assist clinicians in early detection of cardiotoxicity and with treatment guidance. Cardiac troponins and natriuretic peptides are the most studied biomarkers in the determination and monitoring of cardiotoxicity.

Imaging in determining cardiotoxicity: Imaging is an important tool in cardiovascular risk assessment and detection of cardiovascular diseases in patients who will undergo cardiotoxic oncology. Imaging is absolutely necessary at the beginning of the treatment and during treatment.

Cancer and coronary artery diseases (CAD): Increasingly, CAD is seen with increased overall survival and survival in oncology patients. In patients with mild CAD prior to oncological diagnosis, it was observed that CAD progressed more rapidly due to both the effects of some cancer treatments and the proinflammatory and prothrombotic environment that emerged as a result of the cancer itself. Cancer patients with coronary artery disease are a challenging group of patients with scarce data for cardiologists and no evidence-based guidelines are present yet.

Cancer treatment, vascular toxicity and hypertension relationship: Hypertension is the most common cardiovascular disease seen in patients receiving antineoplastic therapy. Both pre-treatment and treatment side effects of hypertension increase the risk of cardiovascular side effects of antineoplastic therapy.

Myocardial and pericardial diseases in cancer patients: Pericarditis and pericardial effusion are the most common forms of pericardial disease seen in cancer patients. The incidence of myocarditis is increasing due to the increased use of immune checkpoint inhibitors. Myocarditis and pericardial diseases in cancer patients require a multidisciplinary approach between cardiology and oncology.

Arrhythmias and anticoagulation in cancer patients: Cancer and atrial fibrillation (AF) are diseases that share common etiology and comorbidities. The risk of developing AF increases in cancer patients. Treatment of AF can be quite difficult in cancer patients, because of the possibility of drug interactions between chemotherapy regimens and anticoagulant agents in cancer patients.

Radiotherapy (RT) and heart: The use of RT has led to improvements in life expectancy in malignancies. However, the side effects that occur in the follow-up of patients who recover and survive after RT cause an increase in mortality. Cardiovascular system diseases appear to be the most important cause of mortality, especially in the follow-up of patients who survive after RT applied to the thoracic region. Today, decreases in side effects are observed thanks to the advances in RT techniques and increasing preventive measures.

In this book, the relationship between hematological/oncological malignancies and heart diseases, cardiac side effects of cancer treatment (chemotherapy, radiotherapy, immune therapy), diagnosis and treatment methods are discussed. The coexistence of these two diseases requires a multidisciplinary approach. It has been prepared with the thought that it will be useful to our colleagues.

Prof. Dr. Sibel ÇATIRLI ENAR
Editor

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