Baseline Cardiac Parameters as Biomarkers of Radiation Cardiotoxicity in Lung Cancer: An NI-HEART Analysis.

Background

Radiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients.

Objectives

The aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying "high risk" patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT).

Methods

The medical records of patients who underwent definitive RT for non-small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death.

Results

Among 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%];

Conclusions

The present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.

Informations de copyright

© 2024 The Authors.

Déclaration de conflit d'intérêts

This analysis was funded by an Irish Clinical Academic Training Programme Fellowship held by Dr Walls, which is supported by the Wellcome Trust and the Health Research Board (203930/B/16/Z), the Health Service Executive National Doctors Training and Planning, and the Health and Social Care, Research and Development Division. The lead author currently holds a Cancer Research UK Post-Doctoral Bursary Award (RCCPOB-Nov22/100010). Dr Walls has received speaker fee from an education event organized by AstraZeneca. Prof Jain has received research support from Boston Scientific; has received consulting fees from Boston Scientific; has received honoraria from Janssen, Astellas, Bayer, Astra Zeneca, Pfizer, and Accord; and has received support for attending meetings and/or travel from Janssen and Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.