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BTOG 2026 | Cardio-oncology risk assessment before lung cancer radiotherapy
Sobaib Nazir, MBBS, Royal Brompton Hospital, London, UK, discusses the importance of cardio-oncology guidelines in patients with lung cancer undergoing radiotherapy, highlighting the need for baseline risk stratification to identify potential cardiovascular risks. Recent guidelines recommend assessing blood pressure, cholesterol, lipids, HbA1c, and ECG, as well as a baseline transthoracic cardiogram, to understand a patient’s baseline risk factors and heart function before starting radiotherapy. This interview took place at the 2026 British Thoracic Oncology Group (BTOG) congress in Edinburgh, UK.
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Transcript
Of course. So we know that radiotherapy is associated with adverse effects on the heart, particularly when you get to higher doses. And there’s a wealth of studies that have actually demonstrated a linear correlation between the amount of radiation delivered to the heart and the amount of damage that occurs in terms of adverse major cardiovascular events. So it’s a really important part of a patient’s workup and also an understanding of the complications is really important for the oncologist to have an awareness about...
Of course. So we know that radiotherapy is associated with adverse effects on the heart, particularly when you get to higher doses. And there’s a wealth of studies that have actually demonstrated a linear correlation between the amount of radiation delivered to the heart and the amount of damage that occurs in terms of adverse major cardiovascular events. So it’s a really important part of a patient’s workup and also an understanding of the complications is really important for the oncologist to have an awareness about. We do now have the first cardio-oncology guidelines published in 2022 which do explicitly state that it’s important to undertake a baseline risk stratification in patients who are due to undergo radiotherapy. Now, what does this mean? Well, the guidelines recommend that patients have a blood pressure check, their cholesterol, lipids, HbA1c, and an ECG done. And these are really important to have a good understanding about what the patient’s baseline risk factors are like before they go into radiotherapy. The guidelines also recommend undertaking a baseline transthoracic cardiogram as well to have an understanding about their heart function before they start radiotherapy. Now, the reason why this is also really important is I mentioned at the beginning that there’s a number of studies that have shown that there’s an increased risk of heart disease following radiotherapy. But the risk factors that are pre-existing increase the future risk as well. So by addressing those risk factors at baseline, we have a much better method of trying to identify which patients need to be followed up and address those cardiovascular issues head on.
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