What question did this study set out to answer?

To evaluate the incidence and clinical predictors of symptomatic cardiac toxicity after dose-escalated thoracic radiotherapy for stage III non–small-cell lung cancer.

February 23, 2017Journal of Clinical OncologyOpen Access

Cardiac Toxicity After Radiotherapy for Stage III Non–Small-Cell Lung Cancer: Pooled Analysis of Dose-Escalation Trials Delivering 70 to 90 Gy

Q: What are the key findings of this study?

Higher heart mean doses during radiotherapy for stage III NSCLC were associated with increased cardiac events, with rates of 4%, 7%, and 21% for doses <10 Gy, 10-20 Gy, and ≥20 Gy, respectively.

Q: What does this research mean for the field?

Higher heart mean doses during radiotherapy for stage III non-small-cell lung cancer are associated with increased rates of cardiac events, with rates of 4%, 7%, and 21% for doses <10 Gy, 10-20 Gy, and ≥20 Gy, respectively. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

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Key result

Higher mean heart radiation doses in NSCLC are linked to cardiac event rates reaching ~21%.

Why the study?

Does higher heart radiation dose increase the risk of symptomatic cardiac events in patients receiving dose-escalated radiotherapy for stage III NSCLC?

Population

112 analyzed patients with stage III non-small-cell lung cancer (ECOG performance status 0 to 1)

Comparison

Dose-escalated thoracic radiotherapy vs Lower heart radiation doses

Design

Cohort

Follow-up

median 8.8 years for surviving patients

Authors

KWKyle WangUniversity of North Carolina at Chapel Hill MEMichael J. EblanUniversity of North Carolina at Chapel Hill ADAllison M. DealUniversity of North Carolina at Chapel Hill

Discussion

Member takes

Implication

May support stricter heart dose limits in stage III NSCLC radiotherapy; extends prior associations but leaves open causal confirmation in prospective trials.

Key Points

To evaluate the incidence and clinical predictors of symptomatic cardiac toxicity after dose-escalated thoracic radiotherapy for stage III non–small-cell lung cancer.
Pooled and analyzed 112 patients with stage III NSCLC treated across six prospective dose-escalation trials (70 to 90 Gy; median 74 Gy) with a median follow-up of 8.8 years for surviving patients.
Evaluated primary symptomatic cardiac endpoints (pericardial effusion, acute coronary syndrome, pericarditis, arrhythmia, and heart failure) using competing risks analysis adjusted for baseline coronary artery disease and WHO/ISH risk scores.
Symptomatic cardiac events occurred in 23% of patients (26/112) at a median of 26 months to the first event, predominantly consisting of arrhythmia (n=12), pericardial effusion (n=7), and myocardial infarction (n=5).
Heart mean dose was independently associated with cardiac events on multivariable analysis (HR 1.03 per Gy, P=0.002), with 2-year competing risk-adjusted event rates of 4% for <10 Gy, 7% for 10 to 20 Gy, and 21% for ≥20 Gy.
Baseline coronary artery disease (P<0.001) and WHO/ISH score (P=0.04) also predicted cardiac events, but heart dose was not significantly associated with overall survival.

Structured PICO

Does higher heart radiation dose increase the risk of symptomatic cardiac events in patients receiving dose-escalated radiotherapy for stage III NSCLC?

Population

112 analyzed patients with stage III non-small-cell lung cancer (ECOG performance status 0 to 1)

Intervention

Dose-escalated thoracic radiotherapy (70 to 90 Gy, median 74 Gy)

Comparator

Lower heart radiation doses (e.g., mean dose <10 Gy vs 10-20 Gy vs ≥20 Gy)

Outcome

Symptomatic cardiac events (composite of symptomatic pericardial effusion, acute coronary syndrome, pericarditis, significant arrhythmia, and heart failure)composite

Higher heart doses during thoracic radiotherapy for stage III NSCLC are independently associated with an increased risk of early symptomatic cardiac events.

Cite This Study

Wang et al. (2017) studied this question. Higher heart mean doses during radiotherapy for stage III NSCLC were associated with increased cardiac events, with rates of 4%, 7%, and 21% for doses <10 Gy, 10-20 Gy, and ≥20 Gy, respectively.

synapsesocial.com/papers/698cd08d2ce5fdb7c907f31d https://doi.org/10.1200/jco.2016.70.0229

Topics

Cardio-oncology

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Implication

May support stricter heart dose limits in stage III NSCLC radiotherapy; extends prior associations but leaves open causal confirmation in prospective trials.

Cardiac Toxicity After Radiotherapy for Stage III Non–Small-Cell Lung Cancer: Pooled Analysis of Dose-Escalation Trials Delivering 70 to 90 Gy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Cardiac Toxicity After Radiotherapy for Stage III Non–Small-Cell Lung Cancer: Pooled Analysis of Dose-Escalation Trials Delivering 70 to 90 Gy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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