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Peer-reviewedCC BY-NC-NDClinical and translational radiation oncology

Left atrial and left ventricular radiation exposure predict long-term cardiovascular events after breast cancer radiotherapy.

  • Aline Van der Vorst1,2
  • Johanna Jacobs3
  • Robin Van Lerberghe3
  • Victor De Foer4
  • Yinsi Ickx5
  • Wen Hui Zhan4
  • Laurence Delombaerde2
  • Annouschka Laenen6
  • Gilles Defraene1
  • Maarten Lambrecht1,2
  • Lucas Van Aelst3
  • Jelle Verhoeven2
3 more authors
  • Adinda Baten2
  • Hilde Janssen2
  • Caroline Weltens1,2
6 affiliations
  1. 1Laboratory of Experimental Radiotherapy, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.
  2. 2Department of Radiation Oncology, UZ Leuven, Herestraat 49, Leuven, 3000, Belgium.
  3. 3Department of Cardiology, UZ Leuven, Herestraat 49, Leuven, 3000, Belgium.
  4. 4Department of Medicine, KU Leuven, Oude Markt 13, Leuven, 3000, Belgium.
  5. 5Department of Biomedical Sciences, KU Leuven, Oude Markt 13, Leuven, 3000, Belgium.
  6. 6Department of Biostatistics and Statistical Bioinformatics, UZ Leuven, Herestraat 49, Leuven, 3000, Belgium.
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Abstract

Background

Adjuvant breast cancer (BC) radiotherapy (RT) improves survival and local control, but cardiovascular (CV) toxicity remains a concern.Aim

This retrospective study investigated the association between RT doses to cardiac substructures and CV toxicity 15 years after BC RT.Methods

Women with unilateral BC diagnosed between 2007 and 2008, treated with RT at [Anonymous] were retrospectively included. Patients with major adverse cardiac events (MACE) were matched to controls by CV risk factors, anthracycline and anti-HER2 therapy. Cardiac substructures were delineated on simulation scans, and multivariable logistic regression was performed to assess associations between RT doses to these substructures and MACE or other CV events.Results

After a median follow-up of 16.5 years (IQR 16.1-17.1), and inclusion of 878 patients, 173 patients experienced MACE and were matched to 167 controls. All patients underwent adjuvant RT using 3-dimensional conformal RT to a total dose of 50 Gy in 25 fractions, with or without a boost to the tumor bed. New individual cardiac toxicities included: atrial fibrillation (AF) 98/878 (11.16%), heart failure (HF) 82/878 (9.34%), coronary artery disease (CAD) 46/878 (5.24%) and valvular disease 180/878 (20.50%). Mean heart doses were 6.62 ± 5.20Gy (MACE) and 5.76 ± 4.96Gy (controls) (p = 0.0916). Compared with controls, patients with MACE had significantly higher disease stage and more frequent histories of CAD, AF and HF. Maximum RT doses to the left atrium (LA) were associated with MACE, new-onset HF, AF and valvular disease, while mean RT dose to the left ventricle (LV) was associated with development of CAD (all p < 0.05).Conclusion

This study demonstrates that patients treated with RT for BC may experience diverse CV toxicities during long-term follow-up. Higher doses to left-sided cardiac substructures, particularly the LA and LV, were associated with specific CV endpoints, while MHD was not associated with toxicity.

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Cite

BibTeXRIS
BibTeX
@article{vorst2026left,
  title = {{Left atrial and left ventricular radiation exposure predict long-term cardiovascular events after breast cancer radiotherapy.}},
  author = {Aline Van der Vorst and Johanna Jacobs and Robin Van Lerberghe and Victor De Foer and Yinsi Ickx and Wen Hui Zhan and Laurence Delombaerde and Annouschka Laenen and Gilles Defraene and Maarten Lambrecht and Lucas Van Aelst and Jelle Verhoeven and Adinda Baten and Hilde Janssen and Caroline Weltens},
  journal = {Clinical and translational radiation oncology},
  year = {2026},
  month = oct,
  doi = {10.1016/j.ctro.2026.101313},
  url = {https://europepmc.org/article/MED/42904112},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Left atrial and left ventricular radiation exposure predict long-term cardiovascular events after breast cancer radiotherapy.
AU  - Aline Van der Vorst
AU  - Johanna Jacobs
AU  - Robin Van Lerberghe
AU  - Victor De Foer
AU  - Yinsi Ickx
AU  - Wen Hui Zhan
AU  - Laurence Delombaerde
AU  - Annouschka Laenen
AU  - Gilles Defraene
AU  - Maarten Lambrecht
AU  - Lucas Van Aelst
AU  - Jelle Verhoeven
AU  - Adinda Baten
AU  - Hilde Janssen
AU  - Caroline Weltens
PY  - 2026
DA  - 2026/10/10
JO  - Clinical and translational radiation oncology
DO  - 10.1016/j.ctro.2026.101313
UR  - https://europepmc.org/article/MED/42904112
AB  - Background  Adjuvant breast cancer (BC) radiotherapy (RT) improves survival and local control, but cardiovascular (CV) toxicity remains a concern.Aim  This retrospective study investigated the association between RT doses to cardiac substructures and CV toxicity 15 years after BC RT.Methods  Women with unilateral BC diagnosed between 2007 and 2008, treated with RT at [Anonymous] were retrospectively included. Patients with major adverse cardiac events (MACE) were matched to controls by CV risk factors, anthracycline and anti-HER2 therapy. Cardiac substructures were delineated on simulation scans, and multivariable logistic regression was performed to assess associations between RT doses to these substructures and MACE or other CV events.Results  After a median follow-up of 16.5 years (IQR 16.1-17.1), and inclusion of 878 patients, 173 patients experienced MACE and were matched to 167 controls. All patients underwent adjuvant RT using 3-dimensional conformal RT to a total dose of 50 Gy in 25 fractions, with or without a boost to the tumor bed. New individual cardiac toxicities included: atrial fibrillation (AF) 98/878 (11.16%), heart failure (HF) 82/878 (9.34%), coronary artery disease (CAD) 46/878 (5.24%) and valvular disease 180/878 (20.50%). Mean heart doses were 6.62 ± 5.20Gy (MACE) and 5.76 ± 4.96Gy (controls) (p = 0.0916). Compared with controls, patients with MACE had significantly higher disease stage and more frequent histories of CAD, AF and HF. Maximum RT doses to the left atrium (LA) were associated with MACE, new-onset HF, AF and valvular disease, while mean RT dose to the left ventricle (LV) was associated with development of CAD (all p < 0.05).Conclusion  This study demonstrates that patients treated with RT for BC may experience diverse CV toxicities during long-term follow-up. Higher doses to left-sided cardiac substructures, particularly the LA and LV, were associated with specific CV endpoints, while MHD was not associated with toxicity.
SN  - 2405-6308
ER  -