Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study
Introduction: It is an ongoing debate how much lung and heart irradiation impact overall survival (OS) after definitive radiotherapy for lung cancer. This study uses a large national cohort of patients with locally advanced NSCLC to investigate the association between OS and irradiation of lung and...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | JTO Clinical and Research Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266636432400033X |
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| author | Agon Olloni, MD, PhD Carsten Brink, PhD Ebbe Laugaard Lorenzen, PhD Stefan Starup Jeppesen, PhD Lone Hofmann, PhD Charlotte Kristiansen, MD Marianne Marquard Knap, MD Ditte Sloth Møller, PhD Lotte Nygård, MD, PhD Gitte Fredberg Persson, MD, PhD Rune Slot Thing, PhD Hella Maria Brøgger Sand, MD Axel Diederichsen, MD, PhD Tine Schytte, MD, PhD |
| author_facet | Agon Olloni, MD, PhD Carsten Brink, PhD Ebbe Laugaard Lorenzen, PhD Stefan Starup Jeppesen, PhD Lone Hofmann, PhD Charlotte Kristiansen, MD Marianne Marquard Knap, MD Ditte Sloth Møller, PhD Lotte Nygård, MD, PhD Gitte Fredberg Persson, MD, PhD Rune Slot Thing, PhD Hella Maria Brøgger Sand, MD Axel Diederichsen, MD, PhD Tine Schytte, MD, PhD |
| author_sort | Agon Olloni, MD, PhD |
| collection | DOAJ |
| description | Introduction: It is an ongoing debate how much lung and heart irradiation impact overall survival (OS) after definitive radiotherapy for lung cancer. This study uses a large national cohort of patients with locally advanced NSCLC to investigate the association between OS and irradiation of lung and heart. Methods: Treatment plans were acquired from six Danish radiotherapy centers, and patient characteristics were obtained from national registries. A hybrid segmentation tool automatically delineated the heart and substructures. Dose-volume histograms for all structures were extracted and analyzed using principal component analyses (PCAs). Parameter selection for a multivariable Cox model for OS prediction was performed using cross-validation based on bootstrapping. Results: The population consisted of 644 patients with a median survival of 26 months (95% confidence interval [CI]: 24–29). The cross-validation selected two PCA variables to be included in the multivariable model. PCA1 represented irradiation of the heart and affected OS negatively (hazard ratio, 1.14; 95% CI: 1.04–1.26). PCA2 characterized the left-right balance (right atrium and left ventricle) irradiation, showing better survival for tumors near the right side (hazard ratio, 0.92; 95% CI: 0.84–1.00). Besides the two PCA variables, the multivariable model included age, sex, body-mass index, performance status, tumor dose, and tumor volume. Conclusions: Besides the classic noncardiac risk factors, lung and heart doses had a negative impact on survival, while it is suggested that the left side of the heart is a more radiation dose–sensitive region. The data indicate that overall heart irradiation should be reduced to improve the OS if possible. |
| first_indexed | 2024-04-24T15:29:36Z |
| format | Article |
| id | doaj.art-1f7e37ea7c9a487c8923f200ecbee833 |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-04-24T15:29:36Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-1f7e37ea7c9a487c8923f200ecbee8332024-04-02T04:15:28ZengElsevierJTO Clinical and Research Reports2666-36432024-04-0154100663Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter StudyAgon Olloni, MD, PhD0Carsten Brink, PhD1Ebbe Laugaard Lorenzen, PhD2Stefan Starup Jeppesen, PhD3Lone Hofmann, PhD4Charlotte Kristiansen, MD5Marianne Marquard Knap, MD6Ditte Sloth Møller, PhD7Lotte Nygård, MD, PhD8Gitte Fredberg Persson, MD, PhD9Rune Slot Thing, PhD10Hella Maria Brøgger Sand, MD11Axel Diederichsen, MD, PhD12Tine Schytte, MD, PhD13Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark; Corresponding author. Address for correspondence: Agon Olloni, MD, Odense University Hospital, Kløvervænget 8, Entrance 109, 5000 Odense C, Denmark.Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, DenmarkDepartment of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, DenmarkDepartment of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, DenmarkDepartment of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, DenmarkDepartment of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkDepartment of Oncology, Aarhus University Hospital, Aarhus, DenmarkDepartment of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, DenmarkDepartment of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, DenmarkDepartment of Oncology, Herlev and Gentofte Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, DenmarkDepartment of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, DenmarkDepartment of Medical Physics, Aalborg University Hospital, Aalborg, DenmarkDepartment of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, DenmarkDepartment of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, DenmarkIntroduction: It is an ongoing debate how much lung and heart irradiation impact overall survival (OS) after definitive radiotherapy for lung cancer. This study uses a large national cohort of patients with locally advanced NSCLC to investigate the association between OS and irradiation of lung and heart. Methods: Treatment plans were acquired from six Danish radiotherapy centers, and patient characteristics were obtained from national registries. A hybrid segmentation tool automatically delineated the heart and substructures. Dose-volume histograms for all structures were extracted and analyzed using principal component analyses (PCAs). Parameter selection for a multivariable Cox model for OS prediction was performed using cross-validation based on bootstrapping. Results: The population consisted of 644 patients with a median survival of 26 months (95% confidence interval [CI]: 24–29). The cross-validation selected two PCA variables to be included in the multivariable model. PCA1 represented irradiation of the heart and affected OS negatively (hazard ratio, 1.14; 95% CI: 1.04–1.26). PCA2 characterized the left-right balance (right atrium and left ventricle) irradiation, showing better survival for tumors near the right side (hazard ratio, 0.92; 95% CI: 0.84–1.00). Besides the two PCA variables, the multivariable model included age, sex, body-mass index, performance status, tumor dose, and tumor volume. Conclusions: Besides the classic noncardiac risk factors, lung and heart doses had a negative impact on survival, while it is suggested that the left side of the heart is a more radiation dose–sensitive region. The data indicate that overall heart irradiation should be reduced to improve the OS if possible.http://www.sciencedirect.com/science/article/pii/S266636432400033XNSCLCDefinitive radiotherapyHeart doseDose to heart chambers and coronary arteriesLung doseOverall survival |
| spellingShingle | Agon Olloni, MD, PhD Carsten Brink, PhD Ebbe Laugaard Lorenzen, PhD Stefan Starup Jeppesen, PhD Lone Hofmann, PhD Charlotte Kristiansen, MD Marianne Marquard Knap, MD Ditte Sloth Møller, PhD Lotte Nygård, MD, PhD Gitte Fredberg Persson, MD, PhD Rune Slot Thing, PhD Hella Maria Brøgger Sand, MD Axel Diederichsen, MD, PhD Tine Schytte, MD, PhD Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study JTO Clinical and Research Reports NSCLC Definitive radiotherapy Heart dose Dose to heart chambers and coronary arteries Lung dose Overall survival |
| title | Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study |
| title_full | Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study |
| title_fullStr | Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study |
| title_full_unstemmed | Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study |
| title_short | Heart and Lung Dose as Predictors of Overall Survival in Patients With Locally Advanced Lung Cancer. A National Multicenter Study |
| title_sort | heart and lung dose as predictors of overall survival in patients with locally advanced lung cancer a national multicenter study |
| topic | NSCLC Definitive radiotherapy Heart dose Dose to heart chambers and coronary arteries Lung dose Overall survival |
| url | http://www.sciencedirect.com/science/article/pii/S266636432400033X |
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