{"id":"84ae64f300c1","type":"article","url":"https://hartvaat.nl/2026/10/20/stralingsgeinduceerde-coronaire-vaatziekte-herkenning-preventie-en-management-bi/","title":"Stralingsgeïnduceerde coronaire vaatziekte: herkenning, preventie en management bij kankeroverlevenden","title_en":"Radiation Vasculopathy of the Coronary Arteries: State-of-the Art Review.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.126.079541","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.126.079541","authors":["Jeffrey Xia","Jean Kim","Abhishek Sharma","Benjamin Yang","Prasanna G Alluri","Katelyn Atkins","Eric D Miller","Terence M Williams","Daniel Addison","Amit Arbune","Alvin Chandra","Efstratios Koutroumpakis","Kathleen W Zhang","Vlad G Zaha"],"significance":7,"published":"2026-10-26","source_date":"2026-10-20","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"Radiation-associated coronary artery disease (RACAD) is an increasingly recognized entity in cancer survivors following thoracic radiotherapy, driven by radiation-induced endothelial dysfunction and accelerated atherosclerosis. Clinical presentation often mimics conventional coronary artery disease but may be overlooked due to overlapping oncologic symptoms; management generally follows standard guidelines while accounting for radiation-specific anatomical and bleeding risks. Prevention through precision radiotherapy and cardiac shielding is paramount, and cardiologists and internists should remain vigilant for this condition while awaiting validated dosimetry-based risk models and surveillance protocols.","created":"2026-10-20T01:03:04Z","updated":"2026-10-20T01:03:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Stralingsgeïnduceerde coronaire vaatziekte (RACAD) komt steeds vaker voor bij kankeroverlevenden na thoracale radiotherapie en vertoont een specifiek pathofysiologisch profiel met endotheeldysfunctie en versnelde atherosclerose. De presentatie lijkt op conventionele coronaire ziekte, maar kan worden gemist door overlap met oncologische symptomen of vermoeidheid; diagnostiek en behandeling volgen standaardrichtlijnen met extra aandacht voor stralingsgerelateerde complicaties en cardiotoxiciteit van systemische therapie. Voor cardiologen en internisten is preventie via precisieradiotherapie en cardiale shielding cruciaal, terwijl nog steeds behoefte bestaat aan gespecialiseerde risicoscores en surveillanceprotocollen.","abstract_original":"Radiation-associated coronary artery disease (RACAD) is a distinct form of coronary artery disease with several specific biological and clinical aspects as well as key knowledge gaps. RACAD is prevalent in patients with cardiac exposure to radiotherapy. As radiotherapy is integral to the effective treatment of many thoracic malignancies, improved long-term survivorship is coupled with increased risk for RACAD. Ionizing radiation induces free radical generation and activation of proinflammatory cascades, leading to endothelial dysfunction and accelerated atherosclerosis. Risks for RACAD are determined both by radiotherapy, including the radiation dose and the proximity of coronary arteries to the radiotherapy field, and by patient-specific factors, such as younger age, higher baseline cardiovascular risk, and concurrent cardiotoxic systemic therapies. Importantly, radiotherapy delivery is highly individualized on the basis of tumor location and treatment strategy, resulting in heterogeneous coronary exposure to radiation and patient-to-patient variability. Clinical presentation may occur early, within 1 to 2 years, especially in patients with higher cardiac radiation doses (eg, lung or esophageal cancer), or after a latency period of 5 to 20 years with lower cardiac dose radiation exposure (eg, left-sided breast cancer). Patients generally present with symptoms similar to conventional coronary artery disease. However, RACAD symptoms may be underrecognized in cancer survivors due to overlapping treatment-related fatigue, pulmonary disease, or competing oncologic symptoms. Diagnosis and management generally follow standard coronary artery disease guidelines while incorporating cancer-specific considerations, such as planned oncologic surgeries, bleeding risk, postradiotherapy complications such as atretic internal mammary arteries, and cardiotoxic effects of systemic cancer therapies. Primary prevention of RACAD is critical, emphasizing advances in precision radiotherapy, including delivery techniques with improved coronary dosimetry, and cardiac shielding. Key knowledge gaps include understanding long-term outcomes with contemporary 3-dimensional conformal radiotherapy techniques, validated cancer-specific risk prediction models on the basis of coronary dosimetry, optimal surveillance protocols, targeted molecular pharmacotherapies, and risk analysis of percutaneous versus surgical management of RACAD. Prospective studies are needed to develop cancer- and dosimetry-specific risk calculators, validating cardioprotective interventions, and improving multidisciplinary cardio-oncology collaboration to optimize early detection of RACAD and timely intervention in the growing population of cancer survivors."}