Coronary Artery Calcifications and Cardiac Risk After Radiation Therapy for Stage III Lung Cancer.

Autor:	Wang K; Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio. Electronic address: kwang545@gmail.com., Malkin HE; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina., Patchett ND; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts., Pearlstein KA; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina., Heiling HM; Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, North Carolina., McCabe SD; Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, North Carolina., Deal AM; Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, North Carolina., Mavroidis P; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina., Oakey M; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina., Fenoli J; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina., Lee CB; Department of Internal Medicine, Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina., Klein JL; Department of Internal Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina; Department of Radiology, University of North Carolina, Chapel Hill, North Carolina., Jensen BC; Department of Internal Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina., Stinchcombe TE; Duke Cancer Institute, Division of Medical Oncology, Duke University, Durham, North Carolina., Marks LB; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina., Weiner AA; Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2022 Jan 01; Vol. 112 (1), pp. 188-196. Date of Electronic Publication: 2021 Aug 19.
DOI:	10.1016/j.ijrobp.2021.08.017
Abstrakt:	Purpose: Heart dose and heart disease increase the risk for cardiac toxicity associated with radiation therapy. We hypothesized that computed tomography (CT) coronary calcifications are associated with cardiac toxicity and may help ascertain baseline heart disease. Methods and Materials: We analyzed the cumulative incidence of cardiac events in patients with stage III non-small cell lung cancer receiving median 74 Gy on prospective dose-escalation trials. Events were defined as symptomatic effusion, pericarditis, unstable angina, infarction, significant arrhythmia, and/or heart failure. Coronary calcifications were delineated on simulation CTs using radiation software program (130 HU threshold). Calcifications were defined as "none," "low," and "high," with median volume dividing low and high. Results: Of 109 patients, 26 had cardiac events at median 26 months (range, 1-84 months) after radiation therapy. Median follow-up in surviving patients was 8.8 years (range, 2.3-17.3). On simulation CTs, 64 patients (59%) had coronary calcifications with median volume 0.2 cm 3 (range, 0.01-8.3). Only 16 patients (15%) had baseline coronary artery disease. Cardiac events occurred in 7% (3 of 45), 29% (9 of 31), and 42% (14 of 33) of patients with no, low, and high calcifications, respectively. Calcification burden was associated with cardiac toxicity on univariate (low vs none: hazard ratio [HR] 5.0, P = .015; high vs none: HR 8.1, P < .001) and multivariate analyses (low vs none: HR 7.0, P = .005, high vs none: HR 10.6, P < .001, heart mean dose: HR 1.1/Gy, P < .001). Four-year competing risk-adjusted event rates for no, low, and high calcifications were 4%, 23%, and 34%, respectively. Conclusions: The presence of coronary calcifications is a cardiac risk factor that can identify high-risk patients for medical referral and help guide clinicians before potentially cardiotoxic cancer treatments. (Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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