Assessment of Prognostic Value of High-Sensitivity Cardiac Troponin T for Early Prediction of Chemoradiation Therapy-Induced Cardiotoxicity in Patients with Non-Small Cell Lung Cancer: A Secondary Analysis of a Prospective Randomized Trial

Xu, Ting; Meng, Qing H.; Gilchrist, Susan C.; Lin, Steven H.; Lin, Ruitao; Xu, Tianlin; Milgrom, Sarah A.; Gandhi, Saumil; Wu, Haijian; Zhao, Yu; Lopez‐Mattei, Juan; Mohan, Radhe; Liao, Zhongxing

doi:10.1016/j.ijrobp.2021.07.035

Cited by 17 publications

(9 citation statements)

References 54 publications

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“…In a study of 225 patients with non‐small cell lung cancer (NSCLC), elevated hs‐cTnT levels during concurrent dual chemotherapy with platinum and paclitaxel and chest radiotherapy were dependent on radiation heart dose. Hs‐cTnT levels were associated with CTRCD and mortality, and routine monitoring of hs‐cTnT could identify patients at high risk of CTRCD due to radiotherapy at an early stage 29 . The study by Finke et al .…”

Section: Discussionmentioning

confidence: 99%

Early diagnostic value of high‐sensitivity cardiac troponin T for cancer treatment‐related cardiac dysfunction: a meta‐analysis

Lv,

Pan,

Guo

et al. 2023

ESC Heart Failure

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Early diagnosis of cancer treatment-related cardiac dysfunction (CTRCD) is important as cancer therapy increases the risk of cardiac dysfunction. High-sensitivity cardiac troponin T (hs-cTnT) is a highly specific marker of myocardial injury. However, its diagnostic value for CTRCD has not been systematically evaluated. This meta-analysis aimed to evaluate whether hs-cTnT could be used as an early diagnostic biomarker for CTRCD. We systematically surveyed PubMed, Embase, Cochrane Library, and Web of Science databases for studies of hs-cTnT for the diagnosis of CTRCD before 1 April 2022. Patients of all ages and all cancer types who underwent echocardiographic left ventricular ejection fraction assessment and blood hs-cTnT and received anticancer therapy (including chemotherapy, radiotherapy, targeted therapy, immune checkpoint inhibitors, and other treatments) were included in this study, resulting in a total of eight studies with 1294 patients. The occurrence of CTRCD was associated with elevated hs-cTnT [sensitivity: 0.78, 95% confidence interval (CI): 0.64-0.88; specificity: 0.75, 95% CI: 0.59-0.86; area under the curve (AUC): 0.83, 95% CI: 0.80-0.86]. We further performed subgroup analysis and found that the AUC of hs-cTnT elevation for the diagnosis of CTRCD increased from 0.83 to 0.90 (95% CI: 0.87-0.92) at 3-6 months, suggesting a higher early diagnostic value of hs-cTnT compared with echocardiography for CTRCD. In terms of clinical applicability, the Fagan plot showed pre-test and post-test probabilities of 51% and 9%, respectively, indicating that hs-cTnT testing can improve the accuracy of clinical diagnosis of CTRCD. However, it was not possible to determine the optimal cut-off value for early diagnosis of CTRCD with hs-cTnT. The Deeks funnel plot was largely symmetrical (P = 0.74); hence, publication bias was not observed. Hs-cTnT allowed early CTRCD diagnosis at 3-6 months. However, further high-quality research is needed to determine the optimal cut-off value for early CTRCD diagnosis with this biomarker.

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Section: Discussionmentioning

confidence: 99%

Early diagnostic value of high‐sensitivity cardiac troponin T for cancer treatment‐related cardiac dysfunction: a meta‐analysis

Lv,

Pan,

Guo

et al. 2023

ESC Heart Failure

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“…Xu et al [74], in their study, stated that elevation of hsTnT during chemoradiation therapy was radiation heart dose-dependent and was associated with cardiac adverse events and mortality. They…”

Section: Role Of Biomarkersmentioning

confidence: 99%

An overview of radiation-induced heart disease

et al. 2022

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Radiation therapy (RT) has dramatically improved cancer survival, leading to several inevitable complications. Unintentional irradiation of the heart can lead to radiation-induced heart disease (RIHD), including cardiomyopathy, pericarditis, coronary artery disease, valvular heart disease, and conduction system abnormalities. Furthermore, the development of RIHD is aggravated with the addition of chemotherapy. The screening, diagnosis, and follow-up for RIHD in patients who have undergone RT are described by the consensus guidelines from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). There is compelling evidence that chest RT can increase the risk of heart disease. Although the prevalence and severity of RIHD are likely to be reduced with modern RT techniques, the incidence of RIHD is expected to rise in cancer survivors who have been treated with old RT regimens. However, there remains a gap between guidelines and clinical practice. Currently, therapeutic modalities followed in the treatment of RIHD are similar to the non-irradiated population. Preventive measures mainly reduce the radiation dose and radiation volume of the heart. There is no concrete evidence to endorse the preventive role of statins, angiotensin-converting enzyme inhibitors, and antioxidants. This review summarizes the current evidence of RIHD subtypes and risk factors and suggests screening regimens, diagnosis, treatment, and preventive approaches.

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“…Secondary analyses of the data are ongoing to understand the role of various factors, including inter-and intra-fractional variations in anatomy, the simplistic assumption about proton RBE, immature technology (PSPT instead of IMPT), and evolving treatment planning techniques. [55][56][57][58][59][60][61][62][63][64][65] • For esophageal cancers, retrospective studies suggested reduced toxicity rates and promising disease control rates with proton therapy. Based on these findings, a multi-institutional randomized trial of protons versus photons for esophageal cancer was conducted.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…Secondary analyses of the data are ongoing to understand the role of various factors, including inter‐ and intra‐fractional variations in anatomy, the simplistic assumption about proton RBE, immature technology (PSPT instead of IMPT), and evolving treatment planning techniques. [ 55–65 ] At the same time a multi‐institutional randomized phase III study “Comparing Photon Therapy To Proton Therapy To Treat Patients With Lung Cancer” (NCT01993810) is underway through NRG and is nearing completion. Another phase II randomized trial “Image‐Guided, Intensity‐Modulated Photon or Proton Beam Radiation Therapy in Treating Patients with Stage II‐IIIB Non‐small Cell Lung Cancer” (NCT01629498) is also being conducted. For esophageal cancers, retrospective studies suggested reduced toxicity rates and promising disease control rates with proton therapy.…”

Section: Clinical Outcomesmentioning

confidence: 99%

A review of proton therapy – Current status and future directions

Mohan

2022

Precision Radiation Oncology

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The original rationale for proton therapy was its highly conformal depth‐dose distributions compared to photons, which allow greater sparing of normal tissues and escalation of tumor doses, thus potentially improving outcomes. Additionally, recent research has revealed previously unrecognized advantages of proton therapy. For instance, the higher relative biological effectiveness (RBE) near the end of the proton range can be exploited to increase the difference in biologically effective dose in tumors versus normal tissues. Moreover, the smaller “dose bath,” that is, the compact nature of proton dose distributions, has been found to reduce the exposure of circulating lymphocytes and the immune organs at risk. There is emerging evidence that the resulting sparing of the immune system has the potential to improve outcomes. Protons accelerated to energies ranging from 70 to 250 MeV enter the treatment head mounted typically on a rotating gantry. Initially, the beams of protons are narrow and, to be suitable for treatments, must be spread laterally and longitudinally and shaped appropriately. Such spreading and shaping may be accomplished electro‐mechanically for the “passively scattered proton therapy” (PSPT) mode; or it may be achieved through magnetic scanning of thin “beamlets” of protons. Intensities of scanning beamlets are optimized to deliver intensity‐modulated proton therapy (IMPT), which optimally balances tumor dose and the sparing of normal tissues. IMPT is presumably the most powerful form of proton therapy. The planning and evaluation of proton dose distributions require substantially different techniques compared to photon therapy. This is mainly due to the fact that proton dose distributions are highly sensitive to inter‐ and intra‐fractional variations in anatomy. In addition, for the same physical dose, the biological effectiveness of protons is different from photons. In the current practice of proton therapy, the RBE is simplistically assumed to have a constant value of 1.1. In reality, the RBE is variable and a highly complex function of numerous variables including energy of protons, dose per fraction, tissue and its environment, cell type, end point, and possibly other factors. While the theoretical potential of proton therapy is high, the clinical evidence in support of its use has so far been mixed. The uncertainties and assumptions mentioned above and the limitations of the still evolving technology of proton therapy may have diminished its true clinical potential. Although promising results have been reported for many types of cancers, they are often based on small studies. At the same time, there have been reports of unforeseen toxicities. Furthermore, because of the high cost of proton therapy, questions are often raised about its value. The general consensus is that there is a need for continued improvement in the state of the art of proton therapy. There is also a need to generate high level evidence of the potential of protons. Fortuitously, such efforts are taking place curr...

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Assessment of Prognostic Value of High-Sensitivity Cardiac Troponin T for Early Prediction of Chemoradiation Therapy-Induced Cardiotoxicity in Patients with Non-Small Cell Lung Cancer: A Secondary Analysis of a Prospective Randomized Trial

Cited by 17 publications

References 54 publications

Early diagnostic value of high‐sensitivity cardiac troponin T for cancer treatment‐related cardiac dysfunction: a meta‐analysis

Early diagnostic value of high‐sensitivity cardiac troponin T for cancer treatment‐related cardiac dysfunction: a meta‐analysis

An overview of radiation-induced heart disease

A review of proton therapy – Current status and future directions

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