TY - JOUR
T1 - Heart dosimetric analysis of three types of cardiac toxicity in patients treated on dose-escalation trials for Stage III non-small-cell lung cancer
AU - Wang, Kyle
AU - Pearlstein, Kevin A.
AU - Patchett, Nicholas D.
AU - Deal, Allison M.
AU - Mavroidis, Panayiotis
AU - Jensen, Brian C.
AU - Lipner, Matthew B.
AU - Zagar, Timothy M.
AU - Wang, Yue
AU - Lee, Carrie B.
AU - Eblan, Michael J.
AU - Rosenman, Julian G.
AU - Socinski, Mark A.
AU - Stinchcombe, Thomas E.
AU - Marks, Lawrence B.
N1 - Funding Information:
Supported in part by NIH grant CA69579 . The study sponsors were not involved in this study’s design or analysis.
Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/11
Y1 - 2017/11
N2 - Background and purpose To assess associations between radiation dose/volume parameters for cardiac subvolumes and different types of cardiac events in patients treated on radiation dose-escalation trials. Material and methods Patients with Stage III non-small-cell lung cancer received dose-escalated radiation (median 74 Gy) using 3D-conformal radiotherapy on six prospective trials from 1996 to 2009. Volumes analyzed included whole heart, left ventricle (LV), right atrium (RA), and left atrium (LA). Cardiac events were divided into three categories: pericardial (symptomatic effusion and pericarditis), ischemia (myocardial infarction and unstable angina), and arrhythmia. Univariable competing risks analysis was used. Results 112 patients were analyzed, with median follow-up 8.8 years for surviving patients. Nine patients had pericardial, seven patients had ischemic, and 12 patients had arrhythmic events. Pericardial events were correlated with whole heart, RA, and LA dose (eg, heart-V30 [p = 0.024], RA-V30 [p = 0.013], and LA-V30 [p = 0.001]), but not LV dose. Ischemic events were correlated with LV and whole heart dose (eg, LV-V30 [p = 0.012], heart-V30 [p = 0.048]). Arrhythmic events showed borderline significant associations with RA, LA, and whole heart dose (eg, RA-V30 [p = 0.082], LA-V30 [p = 0.076], heart-V30 [p = 0.051]). Cardiac events were associated with decreased survival on univariable analysis (p = 0.008, HR 2.09), but only disease progression predicted for decreased survival on multivariable analysis. Conclusions Cardiac events were heterogeneous and associated with distinct heart subvolume doses. These data support the hypothesis of distinct etiologies for different types of radiation-associated cardiotoxicity.
AB - Background and purpose To assess associations between radiation dose/volume parameters for cardiac subvolumes and different types of cardiac events in patients treated on radiation dose-escalation trials. Material and methods Patients with Stage III non-small-cell lung cancer received dose-escalated radiation (median 74 Gy) using 3D-conformal radiotherapy on six prospective trials from 1996 to 2009. Volumes analyzed included whole heart, left ventricle (LV), right atrium (RA), and left atrium (LA). Cardiac events were divided into three categories: pericardial (symptomatic effusion and pericarditis), ischemia (myocardial infarction and unstable angina), and arrhythmia. Univariable competing risks analysis was used. Results 112 patients were analyzed, with median follow-up 8.8 years for surviving patients. Nine patients had pericardial, seven patients had ischemic, and 12 patients had arrhythmic events. Pericardial events were correlated with whole heart, RA, and LA dose (eg, heart-V30 [p = 0.024], RA-V30 [p = 0.013], and LA-V30 [p = 0.001]), but not LV dose. Ischemic events were correlated with LV and whole heart dose (eg, LV-V30 [p = 0.012], heart-V30 [p = 0.048]). Arrhythmic events showed borderline significant associations with RA, LA, and whole heart dose (eg, RA-V30 [p = 0.082], LA-V30 [p = 0.076], heart-V30 [p = 0.051]). Cardiac events were associated with decreased survival on univariable analysis (p = 0.008, HR 2.09), but only disease progression predicted for decreased survival on multivariable analysis. Conclusions Cardiac events were heterogeneous and associated with distinct heart subvolume doses. These data support the hypothesis of distinct etiologies for different types of radiation-associated cardiotoxicity.
KW - Cardiac toxicity
KW - Chemoradiation
KW - Dose escalation
KW - NSCLC
UR - http://www.scopus.com/inward/record.url?scp=85031430458&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85031430458&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2017.10.001
DO - 10.1016/j.radonc.2017.10.001
M3 - Article
C2 - 29050957
AN - SCOPUS:85031430458
SN - 0167-8140
VL - 125
SP - 293
EP - 300
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 2
ER -