Key result
Higher cardiac radiation is linked to MACE and worse survival, identifying a <10% LAD V15 threshold.
Why the study?
The predictive value of radiation dose to the whole heart and cardiac substructures for cardiac events and survival in lung cancer patients remains uncertain.
Does radiation dose to the whole heart and cardiac substructures predict cardiac events and survival in lung cancer patients after radiotherapy?
Meta-Analysis (n=21,645)
Does radiation dose to the whole heart and cardiac substructures predict cardiac events and survival in lung cancer patients after radiotherapy?
Specific dosimetric parameters of the heart and its substructures, such as LAD V15 and mean heart dose, are significant predictors of cardiac events and survival in lung cancer patients undergoing radiotherapy.
LAD V15 may guide substructure sparing in lung RT; extends dosimetric associations but leaves practice change open.
PURPOSE: The predictive value of radiation dose to the whole heart (WH) and cardiac substructures (CS) for cardiac events (CEs) and survival in lung cancer patients remains uncertain. The goal of this study was to conduct a systematic review and meta-analysis to provide an evidence-based estimate of the relationship between these associations. MATERIALS AND METHODS: A systematic meta-analysis was performed following PRISMA guidelines. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Case Series. Outcomes were classified into major adverse cardiac events (MACE), arrhythmias, pericardial effusion, and survival. Depending on heterogeneity, random- or fixed-effects models were applied to calculate pooled hazard ratios (HRs) for univariable and multivariable analyses. RESULTS: A total of 80 studies including 21,645 patients were analyzed. Of these, 25 studies reported cardiac events, and 69 reported survival outcomes. Among 91 WH and 215 CS parameters evaluated, several showed significant associations. Key findings from our meta-analysis include: 1) LAD V15 was significantly associated with MACE. The mean heart dose (MHD), as well as ventricle and LAD doses were significantly associated with ischemic events. 2) Multiple CS parameters were associated with different arrhythmia subtypes. 3) MHD, heart V5/V35/V55 and pericardial doses were significantly associated with pericardial effusion.4) MHD was significantly associated with survival; CS parameters also showed predictive value, and especially, heart base dose being the most significant. 5)We also identified several threshold with potential predictive values, such as LAD V15<10% for MACE, LPV V55 <2% and RPV V10 < 54% for atrial fibrillation (AF), RA V60<0.03cc for non-AF supraventricular tachyarrhythmia (SVT), and LMA V10≥1cc for bradyarrhythmia. CONCLUSION: This study identified 130 WH and CS dosimetric parameters associated with CEs and 131 with survival outcomes. These findings enhance our understanding of radiation-induced heart injury mechanisms and provide guidance for potential protective and intervention strategies.
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Li et al. (2026) conducted a meta-analysis in Lung cancer (n=21,645). Radiation dose to the whole heart and cardiac substructures was evaluated on Cardiac events (MACE, arrhythmias, pericardial effusion) and survival. Radiation dose to the whole heart and cardiac substructures was significantly associated with cardiac events and survival, identifying thresholds like LAD V15 <10% for MACE in lung cancer patients.
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