Heart substructural dosimetric parameters and risk of cardiac events after definitive chemoradiotherapy for stage III non-small cell lung cancer

Jang, Bong Seok; Jin, Myung; Kim, Hak Jae; Oh, Seil; Wu, Hong Gyun; Kim, Eunji; Kim, Byoung Hyuck; Kim, Jae Sik; Chang, Ji Hyun

doi:10.1016/j.radonc.2020.09.050

Cited by 22 publications

(25 citation statements)

References 28 publications

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“…Mentioned investigations go along with the results published by Hart et al, where the authors show that the peak of the dose shift towards the heart is associated with reduced survival [25]. Our investigation confirms the hypothesis of the articles above and goes along with other articles that are published [10][11][12]. Patients who experienced fatal endpoints during followup time received statistically significantly higher doses to the heart's aforementioned subregions.…”

Section: Discussionsupporting

confidence: 89%

“…Higher dose exposure to this region was linked with worse patient survival. Such finding was confirmed by the investigation conducted by Jang et al [10]. His group found that increased dose to the left ventricle increases the acute coronary syndrome risk and impacts patients' survival time diagnosed with NSCLC.…”

Section: Introductionmentioning

confidence: 62%

“…Furthermore, when the total dose of more than 63 Gy was applied to the left atrium, a worser OS was observed. OS worsens by 2.2% [8,10,24]. Moreover, if more than 80% of the pulmonary artery's volume receives a radiation dose of 40 Gy, that lowers the overall survival rate, as well [11].…”

Section: Discussionmentioning

confidence: 99%

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A Pilot Study of Safer Radiation Dosage to the Heart and Its Subregions

et al. 2021

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Background and Objectives: The real impact of ionizing radiation on the heart and poorer overall survival for patients with non small cell lung cancer (NSCLC) remains unclear. This study aims to determine the safe dose constraints to the heart’s subregions that could prevent patients’ early non-cancerous death and improve their quality of life. Methods and Materials: A retrospective cohort study was performed containing 51 consecutive patients diagnosed with stage III NSCLC and treated using 3D, Intensity-modulated radiation therapy (IMRT), and Volumetric modulated arc therapy (VMAT) radiotherapy. For a dosimetric analysis, these structures were chosen: heart, heart base (HB), and region of great blood vessels (GBV). Dose–volume histograms (DVH) were recorded for all mentioned structures. Maximum and mean doses to the heart, HB, the muscle mass of the HB, and GBV were obtained. V10–V60 (%) parameters were calculated from the DVH. After performed statistical analysis, logistic regression models were created, and critical doses calculated. Results: The critical dose for developing a fatal endpoint for HB was 30.5 Gy, while for GBV, it was 46.3 Gy. Increasing the average dose to the HB or GBV by 1 Gy from the critical dose further increases the possibility of early death by 22.0% and 15.8%, respectively. Conclusions: We suggest that the non-canonical sub-regions of the heart (HB and GBV) should be considered during the planning stage. Additional constraints of the heart subregions should be chosen accordingly, and we propose that the mean doses to these regions be 30.5 Gy and 46.3 Gy, respectively, or less. Extrapolated DVH curves for both regions may be used during the planning stage with care.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 62%

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A Pilot Study of Safer Radiation Dosage to the Heart and Its Subregions

et al. 2021

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“…Radiation doses above 30 Gy reportedly increased RIHD by three and a half folds [18,56]. Some of the studies about radiation-related risk factors are summarized in Table 1 [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64].…”

Section: Radiation-related Risk Factorsmentioning

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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“…Despite recent advances in imaging and conformal radiotherapy (RT) techniques, radiation cardiotoxicity is a late occurring treatment sequela for a high proportion of patients receiving treatment for thoracic malignancies [1][2][3][4]. Clinical pathology includes acute coronary syndrome, arrhythmia, exacerbations of heart failure, valvulopathy and pericardial disease, presenting in the monthsyears after treatment [5,6].…”

mentioning

confidence: 99%