Causal relation between heart irradiation and survival of lung cancer patients after radiotherapy.

Autor: Brink C; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark. Electronic address: carsten.brink@rsyd.dk., Bernchou U; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark., Bertelsen A; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark., Hansen O; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Denmark., Schytte T; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Oncology, Odense University Hospital, Denmark., Hjelmborg JVB; Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark., Holloway L; Liverpool and Macarthur Cancer Therapy Centre, Liverpool Hospital, Australia; Ingham Institute for Applied Medical Research, Australia., van Herk M; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom., Johnson-Hart C; The Christie NHS Foundation Trust, Manchester, United Kingdom., Price GJ; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom., Aznar MC; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom., McWilliam A; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom., Faivre-Finn C; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom., Hansen CR; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2022 Jul; Vol. 172, pp. 126-133. Date of Electronic Publication: 2022 May 08.
DOI: 10.1016/j.radonc.2022.05.002
Abstrakt: Introduction: In a recent study, setup uncertainties in the direction of the heart were shown to impact the overall survival of non-small cell lung cancer (NSCLC) patients after radiotherapy, indicating the causal effect between heart irradiation and survival. The current study aims to externally evaluate this observation within a patient cohort treated using daily IGRT.
Method: NSCLC patients with locally-advanced disease and daily CBCT were included. For all treatment fractions, the distance between the isocenter and the heart was evaluated based on the clinical setup registrations. The variation in heart position between planning and treatment (DeltaDistance) was estimated from these registrations. The possible impact of DeltaDistance on survival was analysed by a multivariable Cox model of overall survival, allowing for a time-dependent impact of DeltaDistance to allow for toxicity latency.
Results: Daily CBCT information was available for 489 patients at Odense University Hospital. The primary Cox model contained GTV volume, patient age, performance status, and DeltaDistance. DeltaDistance significantly impacted overall survival approximately 50 months after radiotherapy. Subanalyses indicated that the observed effect is mainly present among the patients with the least clinical risk factors.
Conclusion: Our results confirm the impact of setup variations in the direction of the heart on the survival of NSCLC patients, even within a cohort using daily CBCT setup guidance. This result indicates a causal effect between heart irradiation and survival. It will be challenging to reduce the setup uncertainty even further; thus, increased focus on dose constraints on the heart seems warranted.
Competing Interests: Conflict of interest statement None of the authors has any conflict of interest to declare concerning the current study. Some of the authors acknowledge public research support in the acknowledgement.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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