Faculty Collaboration Database

Dosimetric Predictors of Cardiotoxicity in Thoracic Radiotherapy for Lung Cancer. Clin Lung Cancer 2019 Nov;20(6):435-441

Date

07/16/2019

Pubmed ID

31303452

DOI

10.1016/j.cllc.2019.05.014

Scopus ID

2-s2.0-85068540623 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

BACKGROUND: Higher cardiac radiotherapy (RT) doses when treating lung cancer are associated with worse overall survival (OS), although the direct association between cardiac dose and early cardiotoxicity is poorly understood. We hypothesized that RT doses to the heart and cardiac substructures are associated with under-reported early cardiotoxicity and worse OS.

PATIENTS AND METHODS: We conducted an institutional retrospective review of lung cancer patients treated with conventionally fractionated RT from 2010 to 2015. Collected data included pre-RT cardiac risk factors, post-RT cardiotoxicities, and dose-volume parameters for cardiac substructures. Univariate and multivariate analyses were performed to identify predictors of cardiotoxicity and OS.

RESULTS: Seventy-six cases were evaluated with 1.2 years median follow-up. Cardiotoxicities included atrial arrhythmia (n = 5), pericardial effusion (n = 16), and valvular disease (n = 1). In univariate analysis, significant dose-volume predictors for cardiotoxicity included mean RT dose to structure of interest, volume of structure of interest receiving ≥30 Gy RT dose, and volume of structure of interest receiving ≥45 Gy RT dose (V45) to the atria, ventricles, and pericardium. Higher ventricular V45 was associated with post-RT cardiotoxicity in multivariate analysis (hazard ratio [HR], 1.50; P = .027). Cardiotoxicity occurrence was a highly significant predictor of OS in multivariate analysis (HR, 12.7; P < .001), but higher ventricular V45 alone was not (HR, 0.78; P = .450).

CONCLUSION: Early cardiac events were relatively common after lung cancer RT and associated with multiple cardiac dose-volume parameters. Occurrence of early cardiotoxicity was strongly associated with worse OS. In practice, early cardiotoxicity is under-reported, supporting the need for more detailed cardiac evaluations in high-risk patients to detect and address early cardiotoxicity.

Author List

Borkenhagen JF, Bergom C, Rapp CT, Klawikowski SJ, Rein LE, Gore EM

Authors

Elizabeth M. Gore MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Slade J. Klawikowski PhD Assistant Professor in the Radiation Oncology department at Medical College of Wisconsin
Lisa E. Rein Biostatistician III in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Arrhythmias, Cardiac
Carcinoma, Non-Small-Cell Lung
Cardiotoxicity
Female
Follow-Up Studies
Heart Valve Diseases
Humans
Lung Neoplasms
Male
Middle Aged
Patient Selection
Pericardial Effusion
Prognosis
Radiometry
Radiotherapy
Retrospective Studies
Risk