Statin Use, Heart Radiation Dose, and Survival in Locally Advanced Lung Cancer
| Autor: | Tafadzwa L. Chaunzwa, Udo Hoffmann, Anju Nohria, Raymond H. Mak, Elizabeth H. Baldini, Hugo J.W.L. Aerts, Balaji Tamarappoo, Christopher L. Williams, Danielle S. Bitterman, Katelyn M. Atkins, David Kozono, Rifaquat Rahman |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Lung Neoplasms Statin medicine.drug_class medicine.medical_treatment Radiation Dosage 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Carcinoma Non-Small-Cell Lung Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Lung cancer Retrospective Studies Framingham Risk Score business.industry Proportional hazards model Hazard ratio medicine.disease Confidence interval Radiation therapy Oncology 030220 oncology & carcinogenesis Cohort Cardiology Hydroxymethylglutaryl-CoA Reductase Inhibitors business |
| Zdroj: | Practical Radiation Oncology. 11:e459-e467 |
| ISSN: | 1879-8500 |
| DOI: | 10.1016/j.prro.2020.12.006 |
| Popis: | Patients with locally advanced non-small cell lung cancer (LA-NSCLC) have a high prevalence of pre-existing coronary heart disease and face excess cardiac risk after thoracic radiation therapy. We sought to assess whether statin therapy is a predictor of overall survival (OS) after thoracic radiation therapy.We performed a retrospective analysis of 748 patients with LA-NSCLC treated with thoracic radiation therapy, using Kaplan-Meier OS estimates and Cox regression.Statin use among high cardiac risk patients (Framingham risk ≥20% or pre-existing coronary heart disease; n = 496) was 51.2%. After adjustment for baseline cardiac risk and other prognostic factors, statin therapy was associated with a significantly increased risk of all-cause mortality (adjusted hazard ratio, 1.39; 95% confidence interval [CI], 1.00-1.91; P = .048) but not major adverse cardiac events (adjusted hazard ratio, 1.18; 95% CI, 0.52-2.68; P = .69). Among statin-naïve patients, mean heart dose ≥10 Gy versus10 Gy was associated with a significantly increased risk of all-cause mortality (hazard ratio, 1.32; 95% CI, 1.04-1.68; P = .022), with 2-year OS estimates of 46.9% versus 60.0%, respectively. However, OS did not differ by heart dose among patients on statin therapy (hazard ratio, 1.00; 95% CI, 0.76-1.32; P = 1.00; P-interaction = .031), with 2-year OS estimates of 46.9% versus 50.3%, respectively.Among patients with LA-NSCLC, only half of statin-eligible high cardiac risk patients were on statin therapy, reflecting the highest cardiac risk level of our cohort. Statin use was an independent predictor of all-cause mortality but not major adverse cardiac events. Elevated mean heart dose (≥10 Gy) was associated with increased risk of all-cause mortality in statin-naïve patients but not among those on statin therapy, identifying a group of patients in which early intervention with statins may mitigate the deleterious effects of high heart radiation therapy dose. This warrants evaluation in prospective trials. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|