The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer

Autor: Vivekanandan, S, Landau, DB, Counsell, N, Warren, DR, Khwanda, A, Rosen, SD, Parsons, E, Ngai, Y, Farrelly, L, Hughes, L, Hawkins, M, Fenwick, JD
Jazyk: angličtina
Rok vydání: 2017
Zdroj: Vivekanandan, S, Landau, D B, Counsell, N, Warren, D R, Khwanda, A, Rosen, S D, Parsons, E, Ngai, Y, Farrelly, L, Hughes, L, Hawkins, M A & Fenwick, J D 2017, ' The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer ', International Journal of Radiation Oncology Biology Physics . https://doi.org/10.1016/j.ijrobp.2017.04.026
DOI: 10.1016/j.ijrobp.2017.04.026
Popis: Purpose The heart receives high radiation doses during radiotherapy of advanced-stage lung cancer. We have explored associations between overall survival, cardiac radiation doses and electrocardiographic (ECG) changes in patients treated in IDEAL-CRT, a trial of isotoxically-escalated concurrent chemoradiation delivering tumor doses of 63-73Gy. Patients and Methods Dosimetric and survival data were analyzed for 78 patients. The whole heart, pericardium, AV node, and walls of left and right atria (LA/RA-Wall) and ventricles (LV/RV-Wall) were outlined on radiotherapy planning scans, and differential dose-volume-histograms (dDVHs) were calculated. For each structure, dDVHs were approximated using the average dDVH and the 10 highest ranked structure-specific principal components (PCs). ECGs at baseline and 6 months post-radiotherapy were analyzed for 53 patients, dichotomizing patients according to presence or absence of ‘any ECG change’ (conduction or ischemic/pericarditis-like change). All-cause death-rate (DR) was analyzed from the start of treatment using Cox regression. Results 38% had ECG changes at 6 months. On univariable analysis, higher scores for LA-Wall-PC6, Heart-PC6, ‘any ECG change’ and larger planning target volume (PTV) were significantly associated with higher DR (p = .003, .009, .029 and .037 respectively). Heart-PC6 and LA-Wall-PC6 represent larger volumes of whole heart and left atrial wall receiving 63-69Gy. Cardiac doses ≥63Gy were concentrated in the LA-wall and consequently Heart-PC6 was highly correlated with LA-Wall-PC6. ‘Any ECG change’, LA-Wall-PC6 scores and PTV size were retained in the multivariable model. Conclusion We found associations between higher DR and conduction or ischemic/pericarditis-like changes on ECG at 6 months, and between higher DR and higher Heart-PC6 or LA-Wall-PC6 scores, which are closely related to heart or left atrial wall volumes receiving 63-69Gy in this small cohort of patients.
Databáze: OpenAIRE
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