Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea.
Radiother Oncol. 2020 Nov;152:126-132. doi: 10.1016/j.radonc.2020.09.050. Epub 2020 Oct 12.
We evaluated the incidence of cardiac events after chemoradiotherapy in patients with stage III non-small cell lung cancer (NSCLC) based on baseline cardiovascular risk and the heart substructures' radiation dose.
From 2008 to 2018, the cardiac events of 258 patients with stage III NSCLC who received definitive chemoradiotherapy were reviewed. The 10-year cardiovascular risk was calculated using the Atherosclerotic Cardiovascular Disease (ASCVD) scoring system. Dose-volume histograms were estimated for each cardiac chamber. A multivariate competing-risk regression analysis was conducted to assess each cardiac event's subhazard function (SHR).
The median follow-up was 27.5 months overall and 38.9 months for survivors. Among the 179 deaths, none was definitely related to cardiac conditions. Altogether, 32 cardiovascular events affected 27 patients (10.5%) after chemoradiotherapy. Ten were major cardiac adverse events, including heart failure (N = 6) and acute coronary syndrome (ACS, N = 4). Most cardiovascular events were related to well-known risk factors. However, the volume percentage of the left ventricle (LV) receiving 60 Gy (LV V60) > 0 was significantly associated with ACS (SHR = 9.49, 95% CI = 1.28-70.53, P = 0.028). In patients with high cardiovascular risk (ASCVD score > 7.5%), LV V60 > 0% remained a negative ACS prognostic factor (P = 0.003). Meanwhile, in patients with low cardiovascular risk, the LV radiation dose was not associated with ACS events (P = 0.242).
A high LV radiation dose could increase ACS events in patients with stage III NSCLC and high cardiovascular risk. Pre-treatment cardiac risk evaluation and individualized surveillance may help prevent cardiac events after chemoradiotherapy.
我们基于基线心血管风险和心脏亚结构的辐射剂量，评估了 III 期非小细胞肺癌（NSCLC）患者接受放化疗后的心脏事件发生率。
回顾了 2008 年至 2018 年期间接受根治性放化疗的 258 例 III 期 NSCLC 患者的心脏事件。使用动脉粥样硬化性心血管疾病（ASCVD）评分系统计算 10 年心血管风险。为每个心脏腔室估计剂量-体积直方图。采用多变量竞争风险回归分析评估每个心脏事件的亚危险函数（SHR）。
总的中位随访时间为 27.5 个月，幸存者为 38.9 个月。在 179 例死亡中，没有一例明确与心脏状况有关。共有 32 例心血管事件影响了 27 例（10.5%）患者接受放化疗后。其中 10 例为主要心脏不良事件，包括心力衰竭（N=6）和急性冠脉综合征（ACS，N=4）。大多数心血管事件与已知的危险因素有关。然而，左心室（LV）接受 60Gy 的体积百分比（LV V60）>0 与 ACS 显著相关（SHR=9.49，95%CI=1.28-70.53，P=0.028）。在心血管风险较高的患者（ASCVD 评分>7.5%）中，LV V60>0%仍然是 ACS 的负预后因素（P=0.003）。同时，在心血管风险较低的患者中，LV 辐射剂量与 ACS 事件无关（P=0.242）。
高 LV 辐射剂量可能会增加 III 期 NSCLC 合并高心血管风险患者的 ACS 事件。治疗前的心脏风险评估和个体化监测可能有助于预防放化疗后的心脏事件。
