Cardiac toxicity of adjuvant breast cancer radiotherapy in the targeted therapy era

Q: What are the key findings of this study?

Adjuvant breast cancer radiotherapy can be safely combined with HER-2 inhibitors, but concomitant use with other novel targeted agents requires further safety evaluation due to potential cardiac toxicity.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Breast cancer. Intervention: Adjuvant radiotherapy combined with targeted therapies.

Q: What does this research mean for the field?

Adjuvant breast cancer radiotherapy can be safely combined with HER-2 inhibitors, but concomitant administration with other novel targeted agents requires further safety evaluation regarding potential cardiac toxicity. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Iveta Kolářová; Bohuslav Melichar; Igor Sirák; J Vaňásek; Aleš Hlávka; Kateřina Horáčková; Denisa Pohanková; Milan Vošmik

doi:10.5603/rpor.114490

September 8, 2026Reports of Practical Oncology & RadiotherapyOpen Access

Cardiac toxicity of adjuvant breast cancer radiotherapy in the targeted therapy era

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Key result

HER-2 inhibitors combine safely with breast radiotherapy, but other novel targeted agents pose cardiotoxicity concerns.

Why the study?

Long-term cardiac toxicity from breast cancer radiotherapy and systemic therapies requires evaluation due to increasing survivorship and potential disabling or lethal consequences.

Key Points

To review the mechanisms, clinical risks, and prevention of long-term cardiac toxicity associated with adjuvant radiotherapy and concurrent targeted therapies in breast cancer.
Narrative review examining cardiac risks from radiation and systemic treatments in breast cancer.
Summarized heart dose constraints, advanced radiation delivery techniques, and safety profiles of concurrent targeted agents including HER-2, CDK4/6, and PARP inhibitors.
Historical data established a 7.4% increase in major coronary events per 1 Gy increase in mean heart dose, with doses >= 10 Gy increasing risk by 116%.
In a meta-analysis of 8 post-1989 trials (N=12,167), nodal radiotherapy significantly lowered breast cancer mortality (RR = 0.87, 95% CI: 0.80–0.94, p = 0.0010) and all-cause mortality (RR = 0.90, 95% CI: 0.84–0.96, p = 0.0022).
HER-2 inhibitors (trastuzumab, pertuzumab, lapatinib) demonstrate acceptable safety when combined with radiotherapy, while techniques like deep inspiration breath hold reduce mean heart dose from 1.8 Gy to 1.1 Gy (p < 0.001).

Structured PICO

P

Population

Patients with breast cancer undergoing adjuvant radiotherapy and systemic targeted therapies.

I

Intervention

Adjuvant breast cancer radiotherapy combined with targeted systemic therapies (including trastuzumab, pertuzumab, lapatinib, T-DM1, CDK4/6 inhibitors, PARP inhibitors, and immune checkpoint inhibitors).

O

Outcome

Cardiac toxicity, including ischaemic heart disease, left ventricular dysfunction, and congestive heart failure.safety

Modern radiotherapy techniques effectively reduce heart radiation doses, and concurrent administration of breast radiotherapy with several targeted agents like anti-HER-2 therapies is considered relatively safe, though vigilance is required for newer targeted classes.

Limitations

Lack of precise and unequivocal guidelines for the prevention of cardiotoxicity during breast cancer radiotherapy
Data on the feasibility of concomitant administration of radiotherapy and CDK4/6 inhibitors are based on a low level of evidence

Implication

May inform safe radiotherapy integration with HER-2 inhibitors; leaves open cardiac risks of other targeted agents requiring prospective evaluation.

Abstract

Breast cancer is one of the most common malignant disorders in the population and the most common cancer in women. Advances in diagnosis and treatment result in a permanent cure in the majority of patients with early breast cancer, and these patients survive decades after the diagnosis. Thus, long-term toxic sequelae that may be disabling or even lead to lethal consequences are of major importance. Cardiac toxicity may serve as an example of the importance of long-term follow-up and evaluation of chronic toxicities. The multidisciplinary management of breast cancer encompasses, in addition to radiotherapy, cytotoxic chemotherapy, targeted therapy (including immunotherapy) and hormonal treatment. The aim of the present review is to examine the topic of cardiotoxicity in terms of both radiation and medical oncology.

Discussion

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Cite This Study

Kolářová et al. (2026) conducted a review in Breast cancer. Adjuvant radiotherapy combined with targeted therapies was evaluated. Adjuvant breast cancer radiotherapy can be safely combined with HER-2 inhibitors, but concomitant use with other novel targeted agents requires further safety evaluation due to potential cardiac toxicity.

synapsesocial.com/papers/6ad0fcf33afa093ea9ad008a https://doi.org/10.5603/rpor.114490

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Cardiac toxicity of adjuvant breast cancer radiotherapy in the targeted therapy era

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiac toxicity of adjuvant breast cancer radiotherapy in the targeted therapy era

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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