Key result
Thoracic radiation therapy was not associated with significant early changes in global 3D echocardiography measures across the entire cohort, although patients with lung cancer or lymphoma experienced modest worsening in 3D LVEF and strain.
Why the study?
The study was conducted to characterize early changes in cardiac function after thoracic radiation therapy using 3D echocardiography.
Does thoracic radiation therapy cause early changes in 3D echocardiographic measures of cardiac function in patients with breast cancer, lung cancer, or mediastinal lymphoma?
Cohort (n=69)
No
Does thoracic radiation therapy cause early changes in 3D echocardiographic measures of cardiac function in patients with breast cancer, lung cancer, or mediastinal lymphoma?
Mean Difference: -0.9 (95% CI -2.6–0.8)
p-value: p=0.30
Thoracic radiation therapy for lung cancer and mediastinal lymphoma is associated with early, detectable worsening in 3D echocardiographic measures of cardiac function, particularly global longitudinal strain.
Purpose Our objective was to characterize the early changes in cardiac function after thoracic radiation therapy (RT) using 3D echocardiography. Methods and Materials In a prospective longitudinal cohort study of 69 patients with breast cancer, lung cancer, or mediastinal lymphoma treated with chemotherapy and RT, clinical and 3D echocardiographic data were assessed before, immediately after, and 5 to 9 months after RT completion. 3D left ventricular ejection fraction, global circumferential strain, global longitudinal strain (GLS), average 3D strain, twist, and torsion were quantified. Associations among mean heart dose (MHD), V5, and V30 and early changes in echocardiography-derived measures of cardiac function were assessed with generalized estimating equations. Results The median (quartile 1, quartile 3) estimates of MHD ranged from 1.2 Gy (1.0-1.9) in patients with breast cancer ( n = 39), to 6.8 Gy (4.0-12.5) in patients with mediastinal lymphoma ( n = 17), and 19.4 Gy (11.3-21.7) in patients with lung cancer ( n = 13). There were no significant changes in 3D echocardiography measures in patients with breast cancer over time. However, in patients with lung cancer/lymphoma, there was a worsening in 3D left ventricular ejection fraction, GLS, and average 3D strain from pre-RT to RT completion ( P < .05). This worsening in 3D GLS persisted at 5 to 9 months ( P < .05). Across the entire cohort, MHD, V5, and V30 were not associated with changes in global 3D echocardiography-derived measures ( P > .05). Conclusions Early abnormalities in cardiac function as measured by 3D echocardiography can be detected following RT. Additional work is needed to define the determinants of changes in cardiac function with RT and long-term impact of early changes on clinical outcomes.
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Barrett et al. (2025) conducted a cohort in Breast cancer, lung cancer, or mediastinal lymphoma (n=69). Thoracic radiation therapy vs. Pre-radiation therapy baseline was evaluated on Change in 3D left ventricular ejection fraction (LVEF) from pre-RT to RT completion in the overall cohort (MD -0.9, 95% CI -2.6 to 0.8, p=0.30). Thoracic radiation therapy was not associated with significant early changes in global 3D echocardiography measures across the entire cohort, although patients with lung cancer or lymphoma experienced modest worsening in 3D LVEF and strain.
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