Background: Anticancer treatment is associated with many side effects, including those involving the cardiovascular system. While many studies are available on the effects of radiotherapy (RT) on the left ventricle (LV), studies are lacking on the early effects of RT on the structure and function of the right ventricle (RV). Our study aims to assess, using modern echocardiographic techniques, the effect of irradiation on RV systolic function in the mid-term follow-up of patients undergoing RT for lung cancer (LC). Methods: This single-center, prospective study included consecutive patients with LC who were referred for treatment with definite radiotherapy and chemotherapy (study group) or chemotherapy only (control group). Results: The study included 43 patients with a mean age of 64.9 ± 8.1 years. Cancer treatment-related RV toxicity (CTR-RVT) was found in 17 patients (40%). Early reductions in TAPSE values were observed among patients in the study group (20.3 mm vs. 22.1 mm,p= 0.021). Compared to baseline, there was a significant reduction in RV global longitudinal strain (RV GLS) in the study group immediately after the treatment (−21.1% vs. −18.4%,p= 0.02) and also at 3 months after RT (−21.1% vs. −19.1%,p= 0.021). A significant reduction in the RV FWLS value was also observed at 3 months after the end of the treatment (−23.8% vs. −21.8,p= 0.046). There were no significant changes in the three-dimensional right ventricular ejection fraction (3DRVEF) during the follow-up. We found a correlation (p= 0.003) between the mean dose of radiation to the RV and 3DRVEF when assessed immediately after RT. The mean dose of radiation to the heart correlated with RV free-wall longitudinal strain (RV FWLS) immediately after RT (p= 0.03). Conclusions: RV cardiotoxicity occurs in nearly half of patients treated for lung cancer. TAPSE is an important marker of deterioration of RV function under LC treatment. Compared to 3DRVEF, speckle tracking echocardiography is more useful in revealing deterioration of RV systolic function after radiotherapy.
背景：抗癌治疗伴随多种副作用，其中包含对心血管系统的影响。尽管已有大量研究探讨放疗对左心室的影响，但关于放疗对右心室结构与功能的早期效应研究尚显不足。本研究旨在运用现代超声心动图技术，评估肺癌放疗患者中期随访中放射线对右心室收缩功能的影响。 方法：这项单中心前瞻性研究连续纳入接受根治性放化疗联合治疗（研究组）或单纯化疗（对照组）的肺癌患者。 结果：研究共纳入43例平均年龄64.9±8.1岁的患者。其中17例（40%）出现癌症治疗相关右心室毒性。研究组患者早期出现三尖瓣环收缩期位移值降低（20.3 mm对比22.1 mm，p=0.021）。与基线值相比，研究组在治疗结束后即刻（-21.1%对比-18.4%，p=0.02）及放疗后3个月（-21.1%对比-19.1%，p=0.021）的右心室整体纵向应变值均显著下降。治疗结束3个月后亦观察到右心室游离壁纵向应变值显著降低（-23.8%对比-21.8%，p=0.046）。随访期间三维右心室射血分数未见显著变化。研究发现放疗后即刻评估时，右心室平均照射剂量与三维右心室射血分数存在相关性（p=0.003），而心脏平均照射剂量与放疗后即刻的右心室游离壁纵向应变具有相关性（p=0.03）。 结论：近半数肺癌治疗患者出现右心室心毒性。三尖瓣环收缩期位移是肺癌治疗过程中右心室功能恶化的重要标志。与三维右心室射血分数相比，斑点追踪超声心动图技术在揭示放疗后右心室收缩功能恶化方面更具临床价值。
Effect of Radiotherapy on the Right Ventricular Function in Lung Cancer Patients
肿瘤(癌症)患者之家