Cardiac Substructure Dose and Survival in Stereotactic Radiotherapy for Lung Cancer: Results of the Multi-Centre SSBROC Trial.

Automatic segmentation Cardiac substructures Lung cancer Stereotactic radiotherapy Survival outcome

Journal

Clinical oncology (Royal College of Radiologists (Great Britain))
ISSN: 1433-2981
Titre abrégé: Clin Oncol (R Coll Radiol)
Pays: England
ID NLM: 9002902

Informations de publication

Date de publication:
20 Jul 2024
Historique:
received: 01 04 2024
revised: 10 07 2024
accepted: 17 07 2024
medline: 4 8 2024
pubmed: 4 8 2024
entrez: 3 8 2024
Statut: aheadofprint

Résumé

Stereotactic ablative body radiotherapy (SABR) is increasingly used for early-stage lung cancer, however the impact of dose to the heart and cardiac substructures remains largely unknown. The study investigated doses received by cardiac substructures in SABR patients and impact on survival. SSBROC is an Australian multi-centre phase II prospective study of SABR for stage I non-small cell lung cancer. Patients were treated between 2013 and 2019 across 9 centres. In this secondary analysis of the dataset, a previously published and locally developed open-source hybrid deep learning cardiac substructure automatic segmentation tool was deployed on the planning CTs of 117 trial patients. Physical doses to 18 cardiac structures and EQD2 converted doses (α/β = 3) were calculated. Endpoints evaluated include pericardial effusion and overall survival. Associations between cardiac doses and survival were analysed with the Kaplan-Meier method and Cox proportional hazards models. Cardiac structures that received the highest physical mean doses were superior vena cava (22.5 Gy) and sinoatrial node (18.3 Gy). The highest physical maximum dose was received by the heart (51.7 Gy) and right atrium (45.3 Gy). Three patients developed grade 2, and one grade 3 pericardial effusion. The cohort receiving higher than median mean heart dose (MHD) had poorer survival compared to those who received below median MHD (p = 0.00004). On multivariable Cox analysis, male gender and maximum dose to ascending aorta were significant for worse survival. Patients treated with lung SABR may receive high doses to cardiac substructures. Dichotomising the patients according to median mean heart dose showed a clear difference in survival. On multivariable analyses gender and dose to ascending aorta were significant for survival, however cardiac substructure dosimetry and outcomes should be further explored in larger studies.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE
Stereotactic ablative body radiotherapy (SABR) is increasingly used for early-stage lung cancer, however the impact of dose to the heart and cardiac substructures remains largely unknown. The study investigated doses received by cardiac substructures in SABR patients and impact on survival.
MATERIALS AND METHODS METHODS
SSBROC is an Australian multi-centre phase II prospective study of SABR for stage I non-small cell lung cancer. Patients were treated between 2013 and 2019 across 9 centres. In this secondary analysis of the dataset, a previously published and locally developed open-source hybrid deep learning cardiac substructure automatic segmentation tool was deployed on the planning CTs of 117 trial patients. Physical doses to 18 cardiac structures and EQD2 converted doses (α/β = 3) were calculated. Endpoints evaluated include pericardial effusion and overall survival. Associations between cardiac doses and survival were analysed with the Kaplan-Meier method and Cox proportional hazards models.
RESULTS RESULTS
Cardiac structures that received the highest physical mean doses were superior vena cava (22.5 Gy) and sinoatrial node (18.3 Gy). The highest physical maximum dose was received by the heart (51.7 Gy) and right atrium (45.3 Gy). Three patients developed grade 2, and one grade 3 pericardial effusion. The cohort receiving higher than median mean heart dose (MHD) had poorer survival compared to those who received below median MHD (p = 0.00004). On multivariable Cox analysis, male gender and maximum dose to ascending aorta were significant for worse survival.
CONCLUSIONS CONCLUSIONS
Patients treated with lung SABR may receive high doses to cardiac substructures. Dichotomising the patients according to median mean heart dose showed a clear difference in survival. On multivariable analyses gender and dose to ascending aorta were significant for survival, however cardiac substructure dosimetry and outcomes should be further explored in larger studies.

Identifiants

DOI: 10.1016/j.clon.2024.07.005 PMID: 39097416
pubmed: 39097416
pii: S0936-6555(24)00289-9
doi: 10.1016/j.clon.2024.07.005
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Auteurs

V Chin (V)

University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centres, Department of Radiation Oncology, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia; University of Sydney, Image X Institute, Sydney, Australia. Electronic address: vicky.chin@unsw.edu.au.

P Chlap (P)

University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centres, Department of Radiation Oncology, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia.

R Finnegan (R)

Ingham Institute for Applied Medical Research, Sydney, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Institute of Medical Physics, Sydney, Australia.

E Hau (E)

Crown Princess Mary Cancer Centre, Westmead Hospital, Department of Radiation Oncology, Sydney, Australia; Blacktown Haematology and Cancer Centre, Blacktown Hospital, Department of Radiation Oncology, Sydney, Australia; Westmead Institute of Medical Research, Centre for Cancer Research, Sydney, Australia; University of Sydney, Westmead Clinical School, Sydney, Australia.

A Ong (A)

Crown Princess Mary Cancer Centre, Westmead Hospital, Department of Radiation Oncology, Sydney, Australia.

X Ma (X)

St George Hospital, Division of Cancer Services, Sydney, Australia.

J Descallar (J)

University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia.

J Otton (J)

University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Liverpool Hospital, Department of Cardiology, Sydney, Australia.

L Holloway (L)

University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centres, Department of Radiation Oncology, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia; University of Sydney, Institute of Medical Physics, Sydney, Australia.

G P Delaney (GP)

University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centres, Department of Radiation Oncology, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia.

S K Vinod (SK)

University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Liverpool and Macarthur Cancer Therapy Centres, Department of Radiation Oncology, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia.

Classifications MeSH