ArticleFrontiers in oncology2026
Beyond mean heart dose: differentiated electrocardiographic manifestations and dosimetric mechanisms of cardiac injury in left-sided versus right-sided breast cancer after intensity-modulated radiotherapy.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To investigate dosimetric exposure variations to the whole heart and substructures between left- and right-sided breast cancer patients receiving intensity-modulated radiotherapy (IMRT), and to evaluate their relationships with post-radiotherapy (post-RT) electrocardiogram (ECG) alterations. Methods: Clinical and dosimetric data of 91 breast cancer patients (54 left-sided, 37 right-sided) undergoing postoperative free-breathing IMRT were retrospectively analyzed. Twelve-lead ECGs were regularly monitored during follow-up. Kaplan-Meier analysis evaluated ECG abnormality-free survival. Receiver operating characteristic (ROC) curves compared the predictive values of mean heart dose (MHD) and left ventricular mean dose (LV Results: Target volume configurations (comprehensive regional and internal mammary node irradiation) drove distinct substructure exposure patterns between sides. In left-sided patients, MHD, LV, and left anterior descending artery (LAD) doses were significantly higher than those in right-sided patients (all Conclusion: Early post-RT cardiotoxicity follows a laterality-specific "dual-mechanism model." Left-sided modifications manifest primarily as acute/subacute repolarization surrogates driven by diffuse LV exposure, whereas right-sided modifications present as rhythm-based stress from focal SAN exposure.
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