Jianxin Xue1, Chengbo Han2, Andrew Jackson3, Chen Hu4, Huan Yao5, Weili Wang6, James Hayman7, Weijun Chen8, Jianyue Jin6, Gregory P Kalemkerian9, Martha Matuzsak7, Struti Jolly7, Feng-Ming Spring Kong10. 1. Department of Radiation Oncology, University of Michigan, Ann Arbor, USA; Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. 2. Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China. 3. Departments of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA. 4. Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, USA. 5. Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, USA. 6. Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA. 7. Department of Radiation Oncology, University of Michigan, Ann Arbor, USA. 8. Department of Radiation Oncology, Zhejiang Cancer Hospital, Hanzhou, China. 9. Department of Internal Medicine, University of Michigan, Ann Arbor, USA. 10. Department of Radiation Oncology, University of Michigan, Ann Arbor, USA; Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA. Electronic address: Fxk132@case.edu.
Abstract
BACKGROUND AND PURPOSE: Higher cardiac dose was associated with worse overall survival in the RTOG0617 study. Pericardial effusion (PCE) is a common cardiac complication of thoracic radiation therapy (RT). We investigated whether doses of radiation to the heart and pericardium are associated with PCE and overall survival in patients treated with thoracic radiation for non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: A total of 94 patients with medically inoperable/unresectable NSCLC treated with definitive RT in prospective studies were reviewed for this secondary analysis. Heart and pericardium were contoured consistently according to the RTOG1106 Atlas, with the great vessels and thymus of the upper mediastinal structures included in the upper part of pericardium, only heart chambers included in the heart structure. Clinical factors and dose-volume parameters associated with PCE or survival were identified via Cox proportional hazards modeling. The risk of PCE and death were mapped using DVH atlases. RESULTS: Median follow-up for surviving patients was 58 months. The overall rate of PCE was 40.4%. On multivariable analysis, dosimetric factors of heart and pericardium were significantly associated with the risk of PCE. Pericardial V30 and V55 were significantly correlated with overall survival, but presence of PCE and heart dosimetric factors were not. CONCLUSION: PCE was associated with both heart and pericardial doses. The significance of pericardial dosimetric parameters, but not heart chamber parameters, on survival suggests the potential significance of radiation damage to the cranial region of pericardium.
BACKGROUND AND PURPOSE: Higher cardiac dose was associated with worse overall survival in the RTOG0617 study. Pericardial effusion (PCE) is a common cardiac complication of thoracic radiation therapy (RT). We investigated whether doses of radiation to the heart and pericardium are associated with PCE and overall survival in patients treated with thoracic radiation for non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: A total of 94 patients with medically inoperable/unresectable NSCLC treated with definitive RT in prospective studies were reviewed for this secondary analysis. Heart and pericardium were contoured consistently according to the RTOG1106 Atlas, with the great vessels and thymus of the upper mediastinal structures included in the upper part of pericardium, only heart chambers included in the heart structure. Clinical factors and dose-volume parameters associated with PCE or survival were identified via Cox proportional hazards modeling. The risk of PCE and death were mapped using DVH atlases. RESULTS: Median follow-up for surviving patients was 58 months. The overall rate of PCE was 40.4%. On multivariable analysis, dosimetric factors of heart and pericardium were significantly associated with the risk of PCE. Pericardial V30 and V55 were significantly correlated with overall survival, but presence of PCE and heart dosimetric factors were not. CONCLUSION: PCE was associated with both heart and pericardial doses. The significance of pericardial dosimetric parameters, but not heart chamber parameters, on survival suggests the potential significance of radiation damage to the cranial region of pericardium.
Authors: Azadeh Abravan; Gareth Price; Kathryn Banfill; Tom Marchant; Matthew Craddock; Joe Wood; Marianne C Aznar; Alan McWilliam; Marcel van Herk; Corinne Faivre-Finn Journal: Front Oncol Date: 2022-07-19 Impact factor: 5.738