ORIGINAL RESEARCH article
Front. Med.
Sec. Translational Medicine
Longitudinal Impact of Radiotherapy on Cardiac Function in Cancer Patients: A Retrospective Cohort Study of Risk Factors and Clinical Outcome
Haiyan Qin
Jianfeng Li
Bo Yang
Rong Li
Rui Wu
Maoying Lan
Yongdong Zhuang
Department of Radiation Oncology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Abstract
Introduction: Radiotherapy (RT) is an essential modality for cancer treatment, but it can induce radiation-associated cardiac disease (RACD), leading to long-term cardiovascular complications. Understanding the impact of radiation dose on cardiac function is critical for optimizing oncologic and cardiologic care. This study aims to evaluate the long-term effects of RT on cardiac function, identify dose-dependent changes in left ventricular ejection fraction (LVEF), and determine predictors of major adverse cardiac events (MACE). Methods: A retrospective cohort study was conducted on 196 cancer patients (mean age 55.7 ± 17.1 years; 52.8% male) who received thoracic RT. Baseline and post-treatment LVEF were assessed using echocardiography. Heart dose metrics, including mean heart dose (MHD) and left anterior descending artery (LAD) dose, were analyzed. MACE incidence (myocardial infarction, heart failure, arrhythmias) was recorded. Results: A significant reduction in LVEF was observed post-RT (59.8% ± 4.3% pre-RT vs. 53.2% ± 5.1% post-RT, p < 0.001). Patients receiving an MHD >10 Gy had a 2.8-fold increased risk of LVEF decline (HR = 2.84, 95% CI: 1.92–4.21, p < 0.001). At a median follow-up of 5.2 years, 41 patients (20.9%) developed MACE, including Myocardial infarction (8.2%), Heart failure (14.8%), and atrial fibrillation (11.2%). Higher LAD dose (>15 Gy), pre-existing hypertension (HR = 2.11, p = 0.005), and diabetes (HR = 1.78, p = 0.021) were significant independent predictors. Conclusion: Deleted: : This is a provisional file, not the final typeset article RT is associated with a significant, dose-dependent decline in cardiac function, increasing the risk of MACE. Patients receiving MHD >10 Gy or LAD dose >15 Gy are at the highest risk. Early detection strategies using cardiac imaging and cardioprotective interventions are critical for improving long-term cardiovascular outcomes in cancer survivors.
Summary
Keywords
cardiac disease, Cancer, left ventricular ejection fraction, Major adverse cardiac events, Radiotherapy
Received
28 August 2025
Accepted
28 October 2025
Copyright
© 2025 Qin, Li, Yang, Li, Wu, Lan and Zhuang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Haiyan Qin
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