The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer
Purpose <br/> The heart receives high radiation doses during radiotherapy of advanced-stage lung cancer. We have explored associations between overall survival, cardiac radiation doses and electrocardiographic (ECG) changes in patients treated in IDEAL-CRT, a trial of isotoxically-escalated co...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal article |
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Elsevier
2017
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| _version_ | 1826290914536980480 |
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| author | Vivekanandan, S Landau, D Counsell, N Warren, D Khwanda, A Rosen, S Parsons, E Ngai, Y Farrelly, L Hughes, L Hawkins, M Fenwick, J |
| author_facet | Vivekanandan, S Landau, D Counsell, N Warren, D Khwanda, A Rosen, S Parsons, E Ngai, Y Farrelly, L Hughes, L Hawkins, M Fenwick, J |
| author_sort | Vivekanandan, S |
| collection | OXFORD |
| description | Purpose <br/> The heart receives high radiation doses during radiotherapy of advanced-stage lung cancer. We have explored associations between overall survival, cardiac radiation doses and electrocardiographic (ECG) changes in patients treated in IDEAL-CRT, a trial of isotoxically-escalated concurrent chemoradiation delivering tumor doses of 63-73Gy. <br/><br/> Patients and Methods <br/> Dosimetric and survival data were analyzed for 78 patients. The whole heart, pericardium, AV node, and walls of left and right atria (LA/RA-Wall) and ventricles (LV/RV-Wall) were outlined on radiotherapy planning scans, and differential dose-volume-histograms (dDVHs) were calculated. For each structure, dDVHs were approximated using the average dDVH and the 10 highest ranked structure-specific principal components (PCs). ECGs at baseline and 6 months post-radiotherapy were analyzed for 53 patients, dichotomizing patients according to presence or absence of ‘any ECG change’ (conduction or ischemic/pericarditis-like change). All-cause death-rate (DR) was analyzed from the start of treatment using Cox regression. <br/><br/> Results <br/> 38% had ECG changes at 6 months. On univariable analysis, higher scores for LA-Wall-PC6, Heart-PC6, ‘any ECG change’ and larger planning target volume (PTV) were significantly associated with higher DR (p = .003, .009, .029 and .037 respectively). Heart-PC6 and LA-Wall-PC6 represent larger volumes of whole heart and left atrial wall receiving 63-69Gy. Cardiac doses ≥63Gy were concentrated in the LA-wall and consequently Heart-PC6 was highly correlated with LA-Wall-PC6. ‘Any ECG change’, LA-Wall-PC6 scores and PTV size were retained in the multivariable model. <br/><br/> Conclusion <br/> We found associations between higher DR and conduction or ischemic/pericarditis-like changes on ECG at 6 months, and between higher DR and higher Heart-PC6 or LA-Wall-PC6 scores, which are closely related to heart or left atrial wall volumes receiving 63-69Gy in this small cohort of patients. |
| first_indexed | 2024-03-07T02:51:29Z |
| format | Journal article |
| id | oxford-uuid:add2a30d-3f59-4ff8-a108-85571f6bab98 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T02:51:29Z |
| publishDate | 2017 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:add2a30d-3f59-4ff8-a108-85571f6bab982022-03-27T03:38:31ZThe impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancerJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:add2a30d-3f59-4ff8-a108-85571f6bab98Symplectic Elements at OxfordElsevier2017Vivekanandan, SLandau, DCounsell, NWarren, DKhwanda, ARosen, SParsons, ENgai, YFarrelly, LHughes, LHawkins, MFenwick, JPurpose <br/> The heart receives high radiation doses during radiotherapy of advanced-stage lung cancer. We have explored associations between overall survival, cardiac radiation doses and electrocardiographic (ECG) changes in patients treated in IDEAL-CRT, a trial of isotoxically-escalated concurrent chemoradiation delivering tumor doses of 63-73Gy. <br/><br/> Patients and Methods <br/> Dosimetric and survival data were analyzed for 78 patients. The whole heart, pericardium, AV node, and walls of left and right atria (LA/RA-Wall) and ventricles (LV/RV-Wall) were outlined on radiotherapy planning scans, and differential dose-volume-histograms (dDVHs) were calculated. For each structure, dDVHs were approximated using the average dDVH and the 10 highest ranked structure-specific principal components (PCs). ECGs at baseline and 6 months post-radiotherapy were analyzed for 53 patients, dichotomizing patients according to presence or absence of ‘any ECG change’ (conduction or ischemic/pericarditis-like change). All-cause death-rate (DR) was analyzed from the start of treatment using Cox regression. <br/><br/> Results <br/> 38% had ECG changes at 6 months. On univariable analysis, higher scores for LA-Wall-PC6, Heart-PC6, ‘any ECG change’ and larger planning target volume (PTV) were significantly associated with higher DR (p = .003, .009, .029 and .037 respectively). Heart-PC6 and LA-Wall-PC6 represent larger volumes of whole heart and left atrial wall receiving 63-69Gy. Cardiac doses ≥63Gy were concentrated in the LA-wall and consequently Heart-PC6 was highly correlated with LA-Wall-PC6. ‘Any ECG change’, LA-Wall-PC6 scores and PTV size were retained in the multivariable model. <br/><br/> Conclusion <br/> We found associations between higher DR and conduction or ischemic/pericarditis-like changes on ECG at 6 months, and between higher DR and higher Heart-PC6 or LA-Wall-PC6 scores, which are closely related to heart or left atrial wall volumes receiving 63-69Gy in this small cohort of patients. |
| spellingShingle | Vivekanandan, S Landau, D Counsell, N Warren, D Khwanda, A Rosen, S Parsons, E Ngai, Y Farrelly, L Hughes, L Hawkins, M Fenwick, J The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer |
| title | The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer |
| title_full | The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer |
| title_fullStr | The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer |
| title_full_unstemmed | The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer |
| title_short | The impact of cardiac radiation dosimetry on survival following radiotherapy for non-small cell lung cancer |
| title_sort | impact of cardiac radiation dosimetry on survival following radiotherapy for non small cell lung cancer |
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