Benjamin Y Liu1, Sadiq Rehmani2, Minal S Kale2, Deborah Marshall3, Kenneth E Rosenzweig3, Chung Yin Kong4, Juan Wisnivesky2, Keith Sigel5. 1. Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 2. Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 3. Department of Radiology Oncology, Icahn School of Medicine at Mount Sinai, New York, NY. 4. Department of Radiology, Massachusetts General Hospital, Boston, MA. 5. Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Keith.Sigel@mssm.edu.
Abstract
BACKGROUND: The long-term risk of cardiovascular outcomes from either stereotactic body radiation therapy (SBRT) or three-dimensional conformal radiation therapy (3DCRT) plus intensity-modulated radiation therapy (IMRT) to treat early stage non-small cell lung cancer (NSCLC) is largely unknown. As continued adoption of SBRT accelerates, it is important to delineate unforeseen cardiovascular risks associated with treatment. RESEARCH QUESTION: Does the long-term risk of cardiovascular outcomes for patients with early stage NSCLC treated with either SBRT or 3DCRT plus IMRT differ by tumor laterality? STUDY DESIGN AND METHODS: Data from the Surveillance, Epidemiology, and End Results registry linked to Medicare was analyzed to identify a sample of 3,256 patients (1,506 treated with SBRT and 1,750 treated with 3DCRT plus IMRT) with node-negative stage I or IIA NSCLC. Cardiovascular events were identified using diagnosis codes, and outcomes were compared between left- and right-sided tumors. We assumed that tumor laterality was random and that the radiation field for left-sided tumors likely would result in greater dose to cardiac tissues. Cox regression models were fit to quantify the association of laterality on outcomes. RESULTS: Patients were followed up for a median of 2 years. Those treated with SBRT showed no difference in hazard of any cardiovascular outcomes by tumor laterality, including the cardiovascular composite (hazard ratio [HR] comparing left- vs right-sided tumors, 0.98; 95% CI, 0.84-1.15). In contrast, patients treated with 3DCRT plus IMRT showed a greater risk of congestive heart failure (HR, 1.23; 95% CI, 1.01-1.48) and percutaneous coronary artery intervention (HR, 2.24; 95% CI, 1.12-4.47). INTERPRETATION: Patients with left- vs right-sided early stage NSCLC showed similar rates of cardiovascular events when treated with SBRT. However, these patients also showed higher rates of select cardiac events when they were treated with 3DCRT plus IMRT. This study provides evidence that SBRT may provide a safer option over 3DCRT plus IMRT for patients with left-sided early stage NSCLC and underscores the need for long-term follow-up for patients treated with radiation therapy.
BACKGROUND: The long-term risk of cardiovascular outcomes from either stereotactic body radiation therapy (SBRT) or three-dimensional conformal radiation therapy (3DCRT) plus intensity-modulated radiation therapy (IMRT) to treat early stage non-small cell lung cancer (NSCLC) is largely unknown. As continued adoption of SBRT accelerates, it is important to delineate unforeseen cardiovascular risks associated with treatment. RESEARCH QUESTION: Does the long-term risk of cardiovascular outcomes for patients with early stage NSCLC treated with either SBRT or 3DCRT plus IMRT differ by tumor laterality? STUDY DESIGN AND METHODS: Data from the Surveillance, Epidemiology, and End Results registry linked to Medicare was analyzed to identify a sample of 3,256 patients (1,506 treated with SBRT and 1,750 treated with 3DCRT plus IMRT) with node-negative stage I or IIA NSCLC. Cardiovascular events were identified using diagnosis codes, and outcomes were compared between left- and right-sided tumors. We assumed that tumor laterality was random and that the radiation field for left-sided tumors likely would result in greater dose to cardiac tissues. Cox regression models were fit to quantify the association of laterality on outcomes. RESULTS: Patients were followed up for a median of 2 years. Those treated with SBRT showed no difference in hazard of any cardiovascular outcomes by tumor laterality, including the cardiovascular composite (hazard ratio [HR] comparing left- vs right-sided tumors, 0.98; 95% CI, 0.84-1.15). In contrast, patients treated with 3DCRT plus IMRT showed a greater risk of congestive heart failure (HR, 1.23; 95% CI, 1.01-1.48) and percutaneous coronary artery intervention (HR, 2.24; 95% CI, 1.12-4.47). INTERPRETATION: Patients with left- vs right-sided early stage NSCLC showed similar rates of cardiovascular events when treated with SBRT. However, these patients also showed higher rates of select cardiac events when they were treated with 3DCRT plus IMRT. This study provides evidence that SBRT may provide a safer option over 3DCRT plus IMRT for patients with left-sided early stage NSCLC and underscores the need for long-term follow-up for patients treated with radiation therapy.
Authors: Giovanna Gagliardi; Louis S Constine; Vitali Moiseenko; Candace Correa; Lori J Pierce; Aaron M Allen; Lawrence B Marks Journal: Int J Radiat Oncol Biol Phys Date: 2010-03-01 Impact factor: 7.038
Authors: Christina K Speirs; Todd A DeWees; Sana Rehman; Alerson Molotievschi; Maria A Velez; Daniel Mullen; Sandra Fergus; Marco Trovo; Jeffrey D Bradley; Cliff G Robinson Journal: J Thorac Oncol Date: 2016-10-12 Impact factor: 15.609
Authors: Gregory M M Videtic; Jessica Donington; Meredith Giuliani; John Heinzerling; Tomer Z Karas; Chris R Kelsey; Brian E Lally; Karen Latzka; Simon S Lo; Drew Moghanaki; Benjamin Movsas; Andreas Rimner; Michael Roach; George Rodrigues; Shervin M Shirvani; Charles B Simone; Robert Timmerman; Megan E Daly Journal: Pract Radiat Oncol Date: 2017-06-05
Authors: Yuka Kiyota; Sebastian Schneeweiss; Robert J Glynn; Carolyn C Cannuscio; Jerry Avorn; Daniel H Solomon Journal: Am Heart J Date: 2004-07 Impact factor: 4.749
Authors: Sarah C Darby; David J Cutter; Marjan Boerma; Louis S Constine; Luis F Fajardo; Kazunori Kodama; Kiyohiko Mabuchi; Lawrence B Marks; Fred A Mettler; Lori J Pierce; Klaus R Trott; Edward T H Yeh; Roy E Shore Journal: Int J Radiat Oncol Biol Phys Date: 2010-03-01 Impact factor: 7.038