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Cardiac events after treatment with high dose radiation
therapy +/- chemotherapy for non-small cell lung cancer
Linglong Tang, Anwen Liu, Daniel Gomez, Quynh-Nhu Nguyen, Lawrence B. Levy,Ting
Xu, Ritsuko Komaki, Zhongxing Liao
ASTRO 56th Annual Meeting San Francisco 2014-9-14
• The incidence of new cardiac toxicity is 53.1% (n=160) of 301 NSCLC patients.
• The incidence of new-onset grade 2 or above cardiac toxicity were 47.8%.
• The median time of developing grade 2 or above cardiac toxicity was 8.1 month.
Results
Cardiac Events N (%) Median time(month)Cardiac Toxicity 144(47.8) 8.1 Pericardial effusion (PCE) 118(39.2) 8.7 Ischemia 17(5.6) 8.8 Arrhythmia 25(8.3) 7.8 Heart Failure 12(4.0) 4.8 Valve Abnormalities 21(7.0) 9.6
Distribution of patient characteristics , clinical, and disease factors and their association with PCE
Characteristic N (% of column) HR 95% CI P IMRT
(% of row)PSPT
(% of row) P
Age 0.80 0.53-1.19 0.26 <0.01<70 195(64.8) 127(73.4) 68(53.1) >=70 106(35.2) 46(26.6) 60(46.9)
Gender 1.12 0.78-1.62 0.53 0.64Male 175(58.1) 103(59.5) 72(56.3) Female 126(41.9) 70(40.5) 56(43.8)
Smoking 0.70 0.40-1.22 0.21 0.33Yes 272(90.4) 159(91.9) 113(88.3) No 29(9.6) 14(8.1) 15(11.7)
Diabetes mellitus 0.61 0.33-1.14 0.12 1.0Yes 39(13.2) 22(12.7) 17(13.3) No 262(86.8) 151(87.3) 111(86.7)
Prior cardiac disease 0.76 0.53-1.09 0.14 0.12Yes 182(60.5) 98(56.6) 84(65.6) No 119(39.5) 75(43.4) 44(34.4)
Hypertension 0.80 0.56-1.15 0.23 0.30Yes 151(50.2) 82(47.4) 69(53.9) No 150(49.8) 91(52.6) 59(46.1)
Location of tumor 0.96 0.71-1.30 0.78 <0.01Left 117(38.9) 59(34.1) 58(45.3) Right 169(56.1) 111(64.2) 58(45.3) others 15(5.0) 3(1.7) 12(9.4)
Stage 1.08 0.69-1.68 0.74 <0.01I-II 33(11.0) 15(8.7) 18(14.1) III- IV 248(82.4) 158(91.3) 90(70.3) Recurrence 20(6.6) 0 20(15.6)
Chemotherapy 1.71 0.89-3.26 0.11 <0.01Yes 258(85.7) 160(92.5) 98(76.6) No 43(14.3) 13(7.5) 30(23.4)
Dose-volume parameters
• Multiple heart V5-V75 had cut off values associated with risk of PCE
• Two important constraints were selected using the martingale residuals:
– V5=7% – V75=1%.
• The 2-year incidence of PCE • Group 1 patients 25.5% (n=55)• Group 2 patients 41.6% (n=214)• Group 3 patients 63.2% (n=32)
Effect of DVH group on PCE
Effect of radiotherapy technique and adjuvant chemotherapy on PCE
Effect of adjuvant chemotherapy on PCEEffect of Radiotherapy technique on PCE
• There was no difference in the incidence of PCE between IMRT and Proton therapy group
• The patients with pericarditis-free time more than 2.5 months were analyzed, it was found that adjuvant chemotherapy increase the risk of PCE by univariate analysis (P=0.024)
• The incidence of developing cardiac events after high-dose RT for NSCLC is approximately 50%, with the most common events being pericardial effusion.
• Dose-volume parameter was the independent predictive factor for PCE.
• The risk of PCE varied significantly, depending on radiation dose-volume parameters.
Conclusion