Atkins Katelyn M, Zhang Samuel C, Kehayias Christopher, Guthier Christian, He John, Gasho Jordan O, Bakhtiar Mina, Silos Katrina D, Kozono David E, Zei Paul C, Nohria Anju, Nikolova Andriana P, Mak Raymond H
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
JACC CardioOncol. 2024 Aug 20;6(4):544-556. doi: 10.1016/j.jaccao.2024.07.005. eCollection 2024 Aug.
Arrhythmias are common following radiotherapy for non-small cell lung cancer.
The aim of this study was to analyze the association of distinct arrhythmia classes with cardiac substructure radiotherapy dose.
A retrospective analysis was conducted of 748 patients with locally advanced non-small cell lung cancer treated with radiotherapy. Cardiac substructure dose parameters were calculated. Receiver-operating characteristic curve analyses for predictors of Common Terminology Criteria for Adverse Events grade ≥3 atrial fibrillation (AF), atrial flutter, non-AF and non-atrial flutter supraventricular tachyarrhythmia (SVT), bradyarrhythmia, and ventricular tachyarrhythmia (VT) or asystole were calculated. Fine-Gray regression models were performed (with noncardiac death as a competing risk).
Of 748 patients, 128 (17.1%) experienced at least 1 grade ≥3 arrhythmia, with a median time to first arrhythmia of 2.0 years (Q1-Q3: 0.9-4.2 years). The 2-year cumulative incidences of each arrhythmia group were 8.0% for AF, 2.7% for atrial flutter, 1.8% for other SVT, 1.4% for bradyarrhythmia, and 1.1% for VT or asystole. Adjusting for baseline cardiovascular risk, pulmonary vein (PV) volume receiving 5 Gy was associated with AF (subdistribution HR [sHR]: 1.04/mL; 95% CI: 1.01-1.08; = 0.016), left circumflex coronary artery volume receiving 35 Gy with atrial flutter (sHR: 1.10/mL; 95% CI: 1.01-1.19; = 0.028), PV volume receiving 55 Gy with SVT (sHR: 1.03 per 1%; 95% CI: 1.02-1.05; < 0.001), right coronary artery volume receiving 25 Gy with bradyarrhythmia (sHR: 1.14/mL; 95% CI: 1.00-1.30; = 0.042), and left main coronary artery volume receiving 5 Gy with VT or asystole (sHR: 2.45/mL; 95% CI: 1.21-4.97; = 0.013).
This study revealed pathophysiologically distinct arrhythmia classes associated with radiotherapy dose to discrete cardiac substructures, including PV dose with AF and SVT, left circumflex coronary artery dose with atrial flutter, right coronary artery dose with bradyarrhythmia, and left main coronary artery dose with VT or asystole, guiding potential risk mitigation approaches.
非小细胞肺癌放疗后心律失常很常见。
本研究旨在分析不同类型心律失常与心脏亚结构放疗剂量之间的关联。
对748例接受放疗的局部晚期非小细胞肺癌患者进行回顾性分析。计算心脏亚结构剂量参数。计算不良事件通用术语标准≥3级心房颤动（AF）、心房扑动、非AF和非心房扑动室上性心动过速（SVT）、缓慢性心律失常以及室性心动过速（VT）或心搏骤停预测指标的受试者操作特征曲线分析。进行Fine-Gray回归模型分析（以非心源性死亡作为竞争风险）。
748例患者中，128例（17.1%）经历了至少1次≥3级心律失常，首次心律失常的中位时间为2.0年（四分位间距：0.9 - 4.2年）。各心律失常组的2年累积发生率分别为：AF为8.0%，心房扑动为2.7%，其他SVT为1.8%，缓慢性心律失常为1.4%，VT或心搏骤停为1.1%。校正基线心血管风险后，接受5 Gy照射的肺静脉（PV）容积与AF相关（亚分布风险比[sHR]：1.04/mL；95%置信区间[CI]：1.01 - 1.08；P = 0.016），接受35 Gy照射的左旋冠状动脉容积与心房扑动相关（sHR：1.10/mL；95% CI：1.01 - 1.19；P = 0.028），接受55 Gy照射的PV容积与SVT相关（sHR：每1%为1.03；95% CI：1.02 - 1.05；P < 0.001），接受25 Gy照射的右冠状动脉容积与缓慢性心律失常相关（sHR：1.14/mL；95% CI：1.00 - 1.30；P = 0.042），接受5 Gy照射的左冠状动脉主干容积与VT或心搏骤停相关（sHR：2.45/mL；95% CI：1.21 - 4.97；P = 0.013）。
本研究揭示了与离散心脏亚结构放疗剂量相关的病理生理上不同类型的心律失常，包括AF和SVT与PV剂量相关，心房扑动与左旋冠状动脉剂量相关，缓慢性心律失常与右冠状动脉剂量相关，VT或心搏骤停与左冠状动脉主干剂量相关，为潜在的风险减轻方法提供了指导。
