Locquet Médéa, Jacob Sophie, Geets Xavier, Beaudart Charlotte
Department of Biomedical Sciences, Namur Research Institute for Life Sciences, (NARILIS), Faculty of Medicine, University of Namur, Namur, Belgium.
Clinical Pharmacology and Toxicology Research Unit, Namur Research Institute for Life Sciences, Faculty of Medicine, University of Namur, 5000, Namur, Belgium.
BMC Cancer. 2024 Dec 20;24(1):1556. doi: 10.1186/s12885-024-13281-8.
Lung cancer is a leading cause of cancer mortality and may require high-dose thoracic radiation therapy (RT). However, RT significantly increases the risk of radiation-induced cardiac events, such as pericarditis, cardiomyopathy, and ischemic heart diseases. Despite evidence from clinical trials showing that higher RT doses are associated with poorer survival outcomes due to these cardiac effects, data on dose-volume predictors of such events in lung cancer remain sparse.
To systematically synthesize the incidence of cardiac events following radiation therapy for lung cancer treatment and dose-volume metrics predictors of radiation therapy-induced cardiac events in lung cancer treatment.
This systematic review, registered on PROSPERO (CRD42024565103), adhered to PRISMA guidelines to investigate cardiac events and its dose-volume predictors following high-dose radiation therapy in adults with lung cancer. Data were extracted from longitudinal observational studies and randomized controlled trials. A comprehensive literature search was conducted across MEDLINE, Cochrane CENTRAL, and Embase, with studies selected based on predefined criteria, focusing on clinical cardiac outcomes. Data extraction followed CHARMS guidelines, and study quality was reported using the PROBAST tool. Results were synthesized narratively, with meta-analyses performed where appropriate using R software to estimate pooled effect sizes, heterogeneity, and publication bias.
The systematic review included 21 studies and identified a significant association between high-dose thoracic radiation therapy (RT) and an increased incidence of cardiac adverse events in lung cancer patients. The review revealed that higher dose-volume parameters, notably higher mean heart doses (MHD), were predictive of major cardiac events such as pericardial effusion, arrhythmias, and acute coronary syndrome. The meta-analysis showed a significant 4% (95% confidence interval: 3%-6%) increased probability of the occurrence of cardiac events per additional Gray of MHD, with low heterogeneity among studies (I = 23%). No publication bias was evidenced.
This study underscores the importance of dose-volume parameters as predictors of cardiac adverse events following high-dose thoracic RT in lung cancer treatment. The findings highlight the need for careful consideration of heart dose constraints in RT planning to mitigate the risk of radiation-induced cardiotoxicity, thereby improving the therapeutic ratio for lung cancer patients. Future research should focus on refining these dose constraints and exploring cardioprotective strategies during lung cancer radiotherapy.
肺癌是癌症死亡的主要原因之一，可能需要高剂量胸部放疗（RT）。然而，放疗会显著增加放射性心脏事件的风险，如心包炎、心肌病和缺血性心脏病。尽管临床试验证据表明，由于这些心脏效应，较高的放疗剂量与较差的生存结果相关，但肺癌中此类事件的剂量-体积预测指标的数据仍然稀少。
系统总结肺癌治疗放疗后心脏事件的发生率以及肺癌治疗中放疗诱发心脏事件的剂量-体积指标预测因素。
本系统评价在PROSPERO（CRD42024565103）上注册，遵循PRISMA指南，调查肺癌成人患者高剂量放疗后心脏事件及其剂量-体积预测因素。数据从纵向观察性研究和随机对照试验中提取。在MEDLINE、Cochrane CENTRAL和Embase中进行了全面的文献检索，根据预定义标准选择研究，重点关注临床心脏结局。数据提取遵循CHARMS指南，使用PROBAST工具报告研究质量。结果进行叙述性综合，在适当情况下使用R软件进行荟萃分析，以估计合并效应大小、异质性和发表偏倚。
该系统评价纳入21项研究，确定高剂量胸部放疗（RT）与肺癌患者心脏不良事件发生率增加之间存在显著关联。该评价显示，较高的剂量-体积参数，尤其是较高的平均心脏剂量（MHD），可预测心包积液、心律失常和急性冠状动脉综合征等主要心脏事件。荟萃分析显示，MHD每增加1格雷，心脏事件发生概率显著增加4%（95%置信区间：3%-6%），研究间异质性较低（I² = 23%）。未发现发表偏倚。
本研究强调了剂量-体积参数作为肺癌治疗中高剂量胸部放疗后心脏不良事件预测因素的重要性。研究结果突出了在放疗计划中仔细考虑心脏剂量限制以降低放射性心脏毒性风险的必要性，从而提高肺癌患者的治疗比率。未来研究应专注于完善这些剂量限制，并探索肺癌放疗期间的心脏保护策略。
