Clinical Relevance of Coronary Artery Calcifications in Radiation Oncology

Abstract Purpose of the Review Radiotherapy for malignancies within the chest improves oncologic outcomes but may increase the risk of cardiovascular disease, particularly coronary artery disease. Coronary artery calcifications (CAC) are a validated marker of coronary disease and can be readily identified on routine computed tomography scans used for radiotherapy planning and follow-up. However, its relevance in radiation oncology remains underrecognized. Recent Findings In this review, we examine the evidence supporting CAC identified on radiotherapy planning imaging as a prognostic marker of cardiovascular events. We then discuss how radiation may exacerbate the progression of CAC observed after radiation treatment. Finally, we discuss how considering radiation dose to the heart in the context of CAC may further strengthen our ability to predict cardiovascular outcomes. Summary Recognizing CAC both as a pre-existing risk factor for cardiovascular morbidity and a clinically relevant endpoint impacted by radiotherapy is essential to understanding its implementation into clinical practice to advance the personalization of cardio-oncologic care.