Ni Lisa, Koshy Matthew, Connell Philip, Pitroda Sean, Golden Daniel W, Al-Hallaq Hania, Hubert Greg, Kauffman Greg, McCall Anne, Malik Renuka
University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
University of Chicago Department of Radiation and Cellular Oncology, Chicago, IL, USA.
J Thorac Dis. 2019 Jun;11(6):2229-2239. doi: 10.21037/jtd.2019.06.29.
Recent studies incorporating dose escalated radiation identified heart dose as a predictor of cardiac toxicity in unresectable lung cancer patients. Whether conventionally dosed radiation impacts cardiac events remains unclear.
Stage III lung cancer patients undergoing definitive chemoradiation to 60-70 Gy were analyzed. Clinical and dosimetric factors (mean heart dose, heart V5-60 in 5 Gy increments) were analyzed against freedom from ≥ grade 3 cardiac events and overall survival (OS) by log-rank test. Multivariable analysis (MVA) for factors significant on univariate analysis was performed by Cox proportional hazards.
A total of 108 patients were identified. Median follow-up was 18.0 months. One- and two-year OS were 79% and 61%, respectively. On MVA, gross tumor volume (GTV) ≥98.6 cm [hazard ratio (HR): 2.11, 95% confidence interval (CI): 1.15-3.93, P=0.02] and female gender (HR: 2.01, 95% CI: 1.09-3.73, P=0.03) predicted for worse survival. Twelve patients (11%) developed ≥ grade 3 cardiac events. One- and two-year freedom from cardiac events (FFCE) was 94% and 84% respectively. On MVA, heart V5 ≥49% predicted for cardiac events (HR: 11.44, 95% CI: 1.31-111.60, P=0.03) while female gender was nearly significant (HR: 3.49, 95% CI: 0.97-16.80, P=0.06). Females presented with similar comorbidity scores, GTVs, and relapse rates but experienced higher heart doses than their male counterparts.
Heart V5 ≥49% predicted for cardiac events after chemoradiation. However, cardiac dosimetry was not associated with survival. Rather, female gender and GTV ≥98.6 cm led to worse survival. This study corroborates emerging data that low-dose radiation to the heart impacts cardiac toxicity.
最近纳入剂量递增放疗的研究确定心脏剂量是不可切除肺癌患者心脏毒性的预测指标。常规剂量放疗是否会影响心脏事件仍不清楚。
对接受60 - 70 Gy根治性放化疗的III期肺癌患者进行分析。通过对数秩检验分析临床和剂量学因素（平均心脏剂量、心脏V5 - 60，以5 Gy增量）与≥3级心脏事件的无事件生存率和总生存率（OS）的关系。对单变量分析中有意义的因素进行多变量分析（MVA），采用Cox比例风险模型。
共纳入108例患者。中位随访时间为18.0个月。1年和2年总生存率分别为79%和61%。多变量分析显示，大体肿瘤体积（GTV）≥98.6 cm[风险比（HR）：2.11，95%置信区间（CI）：1.15 - 3.93，P = 0.02]和女性（HR：2.01，95% CI：1.09 - 3.73，P = 0.03）提示生存率较差。12例患者（11%）发生≥3级心脏事件。1年和2年无心脏事件生存率（FFCE）分别为94%和84%。多变量分析显示，心脏V5≥49%提示发生心脏事件（HR：11.44，95% CI：1.31 - 111.60，P = 0.03），而女性接近有统计学意义（HR：3.49，95% CI：0.97 - 16. — 80，P = 0.06）。女性患者的合并症评分、GTV和复发率相似，但心脏剂量高于男性。
心脏V5≥49%提示放化疗后发生心脏事件。然而，心脏剂量学与生存率无关。相反，女性和GTV≥98.6 cm提示生存率较差。本研究证实了新出现的数据，即心脏低剂量放疗会影响心脏毒性。
