Walls Gerard M, Hill Nicola, McMahon Michael, Kearney Brian Óg, McCann Conor, McKavanagh Peter, Giacometti Valentina, Cole Aidan J, Jain Suneil, McGarry Conor K, Butterworth Karl, McAleese Jonathan, Harbinson Mark, Hanna Gerard G
Cancer Centre Belfast City Hospital, Belfast, United Kingdom.
Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom.
JACC CardioOncol. 2024 Jul 2;6(4):529-540. doi: 10.1016/j.jaccao.2024.05.009. eCollection 2024 Aug.
Radiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients.
The aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying "high risk" patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT).
The medical records of patients who underwent definitive RT for non-small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death.
Among 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; < 0.001). Left atrial and left ventricular enlargement on RT planning scans was associated with cumulative incidence of atrial arrhythmia (14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]; = 0.001) and heart failure (13% [95% CI: 8%-18%] vs 6% [95% CI: 3%-10%]; = 0.007) at 5 years, respectively. However, myocardial infarction was not associated with the presence of coronary calcium (4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]; = 0.094). No cardiac imaging metrics were found to be both clinically and statistically associated with survival.
The present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.
由于心脏与肺部在解剖位置上紧密相邻，且肺癌患者中心血管危险因素的患病率较高，放射诱导的心脏毒性在肺癌治疗中构成了重大挑战。
本研究的目的是评估常规可用的临床和基于影像的心脏参数在识别接受放射治疗（RT）后发生主要不良心脏事件（MACE）和死亡的“高危”患者中的预测价值。
回顾性分析了2015年至2020年期间在单一中心使用现代规划技术接受非小细胞肺癌根治性RT的患者的病历。心脏事件由心脏病专家核实，死亡数据通过国家登记处确认。在RT规划扫描上对心脏亚结构进行自动分割，以进行回顾性结构和剂量分析，并检查它们与临床因素的相关性。使用Fine-Gray模型分析关系，同时考虑死亡的竞争风险。
在纳入研究的478例患者中，77例（16%）发生了88次MACE，事件发生的中位时间为16.3个月。既往存在的心脏疾病负担较重与MACE的累积发生率增加相关（55%[95%CI：12%-20%]对16%[95%CI：35%-71%]；<0.001）。RT规划扫描上的左心房和左心室扩大分别与5年时房性心律失常的累积发生率（14%[95%CI：9%-20%]对4%[95%CI：2%-8%]；=0.001）和心力衰竭的累积发生率（13%[95%CI：8%-18%]对6%[95%CI：3%-10%]；=0.007）相关。然而，心肌梗死与冠状动脉钙化的存在无关（4.2%[95%CI：2%-7%]对0%[95%CI：0%-0%]；=0.094）。未发现任何心脏影像指标在临床和统计学上与生存率相关。
目前的研究结果表明，心脏病史和RT规划扫描参数可能在肺癌患者RT后前瞻性评估心脏毒性风险方面具有潜在用途。
