Aug 2026· European Heart Journal, Supplement· Vol 28· 0 citations
TL;DR
Overall survival was poorer in patients with cardiac comorbidity than in those without, particularly among those receiving a higher CAA dose, while absolute survival estimates suggested a clinically meaningful benefit of lower CAA dose among patients with pre-existing CVD, supporting the potential importance of CAA minimisation in this higher-risk group.
Abstract
Lung cancer and cardiovascular disease (CVD) share common aetiologies and about a quarter of patients treated for lung cancer have CVD. Thoracic radiotherapy is the mainstay of treatment for patients with inoperable lung cancer. However, incidental exposure of the heart to radiation can lead to adverse events and death. People with pre-existing CVD may be more sensitive to heart irradiation.
The RAPID-RT study uses ‘real-world’ data and a ‘rapid-learning’ methodology to evaluate the impact of reducing the radiation dose to a defined cardiac avoidance area (CAA), comprising the right atrium, aortic valve root and coronary arteries.
To examine the potentially modifying effects of pre-existing CVD and level of CAA dose delivered on survival.
Patients with stage I–III lung cancer treated with curative-intent radiotherapy (≥40Gy in >10 fractions, excluding stereotactic ablative radiotherapy), 01/2021-08/2025. From 04/2023, patients were enrolled in RAPID-RT, applying a CAA dose constraint of 19.5Gy in 20 fractions (or equivalent) unless conflicting with tumour coverage. Patients were categorised according to CAA dose above (>19.5Gy) or below (≤19.5Gy).
Clinical, treatment, comorbidity, and survival data were extracted from the electronic patient record, with comorbidities recorded using the Adult Comorbidity Evaluation-27. Missing data were addressed using multiple imputation. Survival was analysed using parametric Weibull proportional hazards models, including an interaction between pre-existing CVD and CAA dose, with adjustment for key prognostic clinical and treatment-related covariates. Adjusted 12-month survival probabilities and absolute survival differences were estimated for a typical patient.
1,880 patients were included, of whom 788 received higher CAA dose. 411 (21.9%) had pre-existing CVD.
Among patients with CVD, lower CAA dose was associated with a 4.2 percentage point (pp) improvement in 12-month survival, compared with 1.5 pps among those without cardiac comorbidity. Overall survival was poorer in patients with cardiac comorbidity than in those without, particularly among those receiving a higher CAA dose (−5.7 pps), with a less pronounced difference at lower dose (−3.0 pps).
However, CVD was not significantly associated with mortality among patients receiving either a higher CAA dose (HR 1.26 95%CI 0.98–1.64), or a lower dose (HR 1.17 95%CI 0.91–1.50). There was no evidence of interaction on the hazard ratio scale (HR for interaction 0.93, p=0.67).
Although no statistically significant interaction was observed on the HR scale, the absence of statistical significance should be interpreted cautiously given the limited power to detect effect modification. In contrast, absolute survival estimates suggested a clinically meaningful benefit of lower CAA dose among patients with pre-existing CVD, supporting the potential importance of CAA minimisation in this higher-risk group.
BACKGROUND
Thoracic radiotherapy (RT) results in pulmonary fibrosis that has been hypothesised to increase the risk of pulmonary hypertension (PH); however, dose effects to cardiopulmonary structures predicting PH have not been systematically studied.
METHODS
Multi-institutional retrospective cohort analysis of patients with non-small cell lung cancer treated with thoracic RT. The pulmonary arteries (PA), distal pulmonary vasculature, lungs and heart were segmented. Radiotherapy dose parameters (mean, maximum and volume (V) receiving X Gy in 5 Gy increments) were extracted. Area under the receiver operating curve (AUROC) analyses estimating PH and Fine-Gray regressions were performed.
RESULTS
Of 848 patients included (n=746 discovery; n=102 validation), 49.9% were women and the median age was 65 years (IQR, 58-73 years). The 2-year cumulative incidence of PH was 11.6%. PA V10 Gy demonstrated the highest AUROC for predicting PH (0.58) and was significantly associated with the risk of PH on multivariable regression adjusting for cardiopulmonary risk factors in the discovery (subdistribution HR (sHR) 1.01; 95% CI 1.00 to 1.02; p=0.013) and validation (sHR 1.03, 95% CI 1.00 to 1.05; p=0.019) cohorts. In those who developed PH after RT (vs PH-negative), moderate or greater tricuspid disease and right ventricular systolic dysfunction (RVSD) were more common (18.7% vs 0.2% (p<0.001) and 3.3% vs 0.2% (p=0.003), respectively).
CONCLUSIONS
PH was common following thoracic RT and associated with PA radiation dose. Patients with PH were more likely to harbour tricuspid disease and RVSD. These hypothesis-generating findings are suggestive that PH following thoracic RT may occur through a pathophysiological process distinct from RT-induced pulmonary fibrosis.
K. Atkins, Samuel C. Zhang, C. Kehayias et al.· Thorax· 0 citations
It is recommended that patients with lung cancer undergo screening to assess their cardiovascular risk and related complications and it is recommended that patients with lung cancer undergo screening to assess their cardiovascular risk and related complications.
M. Mamedov, P. I. Skopin, A. K. Karimov· Russian Journal of Preventiv...· 0 citations
Cardiovascular disease (CVD) is the leading cause of non–cancer-related morbidity and mortality among patients treated for head and neck cancer (HNC). However, the extent to which these patients are screened for CVD remains unclear, and the long-term impact of different anticancer treatment modalities for HNC on the CVD risk is also not well established. A validated marker of subclinical atherosclerosis such as the carotid intima–media thickness (cIMT) might be useful to predict CVD in these patients.
The aim of this study was to assess cIMT and cardiovascular risk factors in patients treated for HNC more than two years after treatment completion.
This is a single-centre, cross-sectional observational study, in which patients ≥18 years old who had completed treatment for HNC (surgery or radiotherapy, post-operative radio(chemo)therapy, or radio(chemo)therapy) at least two years prior underwent an outpatient cardiovascular risk assessment. Primary endpoint was the maximum cIMT, measured in μm on both sides by means of ultrasound. Secondary endpoints included associations of cIMT with low-density lipoprotein cholesterol, systolic blood pressure, use of lipid-lowering drugs, and use of antihypertensives via linear regression, as well as the proportion of patients who required modifications in medication for cardiovascular risk management. Differences between two independent groups were analysed using independent-samples t-tests, and comparisons among more than two groups were performed using one-way ANOVA.
From December 2022 to December 2025, 112 patients were included with a median time after treatment completion of 32.5 months (IQR 26.0-46.2). Compared to their expected cIMT based on their sex and age reference population, patients had a significantly higher cIMT (cIMT observed 927 μm, expected 679 μm; mean difference (MD) 248 μm; 95% CI: 213 to 282 μm; p<0.001). No significant differences in cIMT were found between the different HNC treatment modalities (p=0.453). After correction for age, sex, smoking, diabetes and alcohol use, both LDL-cholesterol (B= 32.8 μm per mmol/L; 95% CI: -7.53 to 73.2; p= 0.110) and systolic blood pressure (B: 1.68 μm per mmHg; 95% CI: -0.23 to 3.59; p= 0.097) tended to associate with cIMT. Patients treated with lipid-lowering drugs (MD: -44.3 μm; 95%CI: -108 to 19.1 μm; p=0.169) or antihypertensive medication (MD: -103 μm; 95%CI: -79.4 to 59.2 μm; p=0.773) did not have a lower cIMT than patients without these treatments. Lipid-lowering therapy was initiated in 41% of previously untreated patients and antihypertensive therapy in 14%.
Patients treated for head and neck cancer exhibited a substantially increased cIMT, suggesting elevated vascular risk. Preventive therapy was frequently initiated, highlighting the importance for systematic cardiovascular risk assessment in these patients.
T. Uyl, A. Yusof, S. Soerahi et al.· European Heart Journal, Supp...· 0 citations
AIMS
Cardiac exposure to radiation is associated with an increased risk of cardiovascular morbidity. Radiation therapy technologies have developed to provide target dose coverage with less exposure to adjacent organs. We investigated trends in cardiac exposure among patients treated with curative-intent radiotherapy from a single institution.
MATERIALS AND METHODS
A total of 10,215 treatment courses were analyzed from 9,966 patients treated for intrathoracic or breast cancers in 2009-2020. Hearts were redelineated using an artificial intelligence model to ensure consistency. Cardiac doses were extracted in 3D and converted, voxel-by-voxel, to equi-effective doses in 2 Gy fractions (EQD2) using α/β = 2 Gy. The mean heart dose (in EQD2) and volume exposed to 5 and 40 Gy, respectively, were extracted. Time trends were investigated for each diagnosis.
RESULTS
Patients with esophageal cancer had the highest mean heart dose (median = 11.67 Gy; IQR = 2.85-18.18), while patients treated for right-sided breast cancer (median = 0.34 Gy; IQR = 0.21-0.51) and lymphoma (median = 0.01 Gy; IQR = 0.00-0.38) had the lowest. A decreasing trend over time was seen most clearly for patients with esophageal and lung cancers (P < .05). For left-sided/bilateral breast cancer, volume exposed to 5 Gy increased over time (P = .032).
CONCLUSION
Radiation exposure to the heart decreased significantly in patients treated between 2009 and 2020, likely due to increased awareness of cardiovascular toxicity and technological developments. For left-sided/bilateral breast cancer, V5 increased significantly, possibly related to increased prioritization of target coverage.
N. Forbes, B. B. Irankunda, C. Terrones-Campos et al.· Clinics in oncology· 0 citations
Evaluating the occurrence of new-onset CVD in women with breast cancer undergoing chemotherapy and identifying factors associated with increased risk of cardiovascular disease highlights the need for sustained cardiovascular surveillance in breast cancer survivors.
V. Dvorovy, L. Kováčová, M. Selvek et al.· European Heart Journal, Supp...· 0 citations
Cardiovascular disease (CVD) is a leading non-cancer cause of morbidity and mortality among survivors of lung cancer and other thoracic malignancies treated with radiotherapy. Thoracic radiotherapy can accelerate atherosclerosis, especially in patients with pre-existing cardiovascular risk factors. Coronary artery calcification (CAC) on CT is a validated predictor of future cardiovascular events. However, data on CAC progression after mediastinal radiotherapy in lung cancer patients are limited.
To evaluate changes in CAC on non-gated chest CT before and after mediastinal radiotherapy in lung cancer patients, and to explore associations with cardiac radiation dose and ASCVD risk.
We retrospectively analyzed 30 patients with histologically confirmed lung cancer treated with curative mediastinal radiotherapy (2019–2024) who had pre- and post-treatment chest CT scans. CAC was quantified using Agatston score, calcium volume, mass, and MESA score. Wilcoxon and Chi-square tests assessed changes; Spearman analysis evaluated correlations with radiation dose and ASCVD risk. ROC curves tested whether the number of radiotherapy sessions predicted CAC presence. Significance was set at p<0.05.
Mean age was 67.3±11.7 years; 50% were female. Adenocarcinoma was most common (43.3%). Median radiotherapy sessions were 25 (range 5–46). Post-radiotherapy, CAC increased significantly in the left main (p=0.018), left anterior descending (p=0.004), and right coronary artery (p=0.010), as well as in total score, volume, mass, and MESA score (all p≤0.033). The number of affected arteries and severity also increased (p<0.001). No correlations were observed between total or mean cardiac radiation dose and CAC changes (p=0.205, 0.288). CAC change negatively correlated with ASCVD risk (rho=-0.687, p<0.001). ROC analysis did not identify a predictive threshold for radiotherapy sessions (AUC 0.51).
Mediastinal radiotherapy in lung cancer patients is associated with significant increases in CAC, affecting more coronary arteries with greater severity. While radiation dose was not directly correlated, CAC assessment via routine chest CT provides a practical tool for cardiovascular risk stratification. Early detection of CAC may inform preventive interventions and cardioprotective strategies in this high-risk population.Difference in calcium score and CAC-DRS Changes in CAC-DRS after radiation
M. Rios, J. A. Cuenca, D. Romero Zertuche et al.· European Heart Journal, Supp...· 0 citations
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