Durvalumab provides important clinical benefit, including longer overall and progression-free survival compared to placebo in patients with stage III NSCLC and PD-L1 ≥ 25%.
Does radiation dose to the right atrium and sinoatrial node increase the risk of de novo atrial fibrillation and heart disease in patients with non-small cell lung cancer?
Higher radiation doses to the right atrium and sinoatrial node are associated with an increased risk of de novo atrial fibrillation and heart disease in patients receiving radiotherapy for non-small cell lung cancer.
Background and purpose: Radiotherapy (RT) is a key treatment for locally advanced non-small cell lung cancer (NSCLC). Tumours near the heart may result in unintended cardiac radiation exposure, increasing the risk of cardiotoxicity, such as de novo atrial fibrillation (DNAF) and de novo heart diseases (DNHD) as ischemic heart disease, heart failure, arterial hypertension or sudden cardiac death. This study investigated associations between radiation dose to cardiac substructures and risk of DNAF and DNHD.Patient/material and methods: This retrospective cohort study included patients treated between January 1, 2010, and December 31, 2020 for NSCLC with definitive RT. The heart, right atrium (RA) and sinoatrial node (SAN) were delineated. Associations between dose-volume parameters and cardiac outcomes were analysed using multivariable models adjusted for relevant confounders. Kaplan-Meier curves estimated survival; p-values < 0.05 were significant.Results: Among 273 included patients, 9.5% had AF pre-RT and 12.8% developed DNAF. DNAF was significantly associated with SAN Dmax (hazard ratio HR = 1.01), RA Dmax (HR = 1.02), RA Dmean (HR = 1.03), mean heart dose (MHD) (HR = 1.04) and heart V40Gy (HR = 1.03). One-year probabilities of DNAF and DNHD were 9.3% and 11%, increasing to 12.2% and 13.2% at 2 years. DNHD was significantly associated with SAN Dmax (HR = 1.02), RA Dmax (HR = 1.02), RA Dmean (HR = 1.04), MHD (HR = 1.06), heart V25Gy (HR = 1.03) and V40Gy (HR = 1.03). Interpretation: The RA and SAN may be considered organs at risk in future RT planning. Minimising cardiac radiation is important to reduce DNAF and DNHD risk. Validation in an independent cohort is warranted.
Graven-Nielsen et al. (2026) studied Patients with stage III non-small cell lung cancer and PD-L1 expression ≥ 25% who have received curative-intent chemoradiotherapy (n=340). Durvalumab vs. Placebo was evaluated on Overall survival and progression-free survival. Durvalumab provides important clinical benefit, including longer overall and progression-free survival compared to placebo in patients with stage III NSCLC and PD-L1 ≥ 25%.