Lung cancer radiotherapyDose to heart substructures is associated with non-cancer death after SBRT in stage I–II NSCLC patients
Section snippets
Patient characteristics
From 2005 to 2013, 1337 patients with mostly peripheral, inoperable stage T1a–T2bN0 NSCLC were treated with SBRT in five different international institutes (The Netherlands Cancer Institute, Amsterdam, The Netherlands; William Beaumont Hospital, Royal Oak, Michigan; University of Wuerzburg, Wuerzburg, Germany; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; and Thomas Jefferson University Hospital, Philadelphia, PA). Eight-hundred and three patients were included (
Results
Patient characteristics: Four-hundred and thirty-one were male, 372 female, with a median age of 74.8 years (41–92 years). The median tumor diameter was 2.24 cm (0.7–7 cm), 3% of patients had a tumor >5 cm. Sixteen percent of patients had a central tumor (within 2 cm of the proximal bronchus, RTOG 0236 definition). Tumors were mostly located in the upper lobes (63.6%).
The median follow-up was 34.8 months (range 0.1–121.5) calculated using the Kaplan–Meier method [12]. The 2 year Kaplan–Meier overall
Discussion
In this analysis of 803 early stage NSCLC patients treated with SBRT, doses to most heart substructures were significantly associated with non-cancer death, where doses to the left atrium and superior vena cava showed the strongest significant association after a multivariate analysis. Strong correlations between doses to the various heart substructures make it difficult to obtain dose constraints, and this work was not designed to obtain these. However, this work does show that the doses to
Conflict of interest
This work was sponsored in part by a research grants from Elekta Oncology Systems Ltd.
Co-author Nicolette O'Connell is an employee of Elekta Oncology Systems Ltd.
Acknowledgements
This work was sponsored in part by a research grant from the Dutch Cancer Society (NKI 2009-4568).
References (27)
- et al.
Radiation-related heart disease: current knowledge and future prospects
Int J Radiat Oncol Biol Phys
(2010) - et al.
Cardiac complications of thoracic irradiation
J Am Coll Cardiol
(2013) - et al.
Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): A randomised, two-by-two factorial phase 3 study
Lancet Oncol
(2015) - et al.
Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer
Int J Radiat Oncol Biol Phys
(2011) - et al.
The simultaneous boost technique: the concept of relative normalized total dose
Radiother Oncol
(1991) - et al.
A note on quantifying follow-up in studies of failure time
Control Clin Trials
(1996) - et al.
Cardiac doses from Swedish breast cancer radiotherapy since the 1950s
Radiother Oncol
(2009) - et al.
Cardiotoxic effects of tangential breast irradiation in early breast cancer patients: the role of irradiated heart volume
Int J Radiat Oncol Biol Phys
(2007) - et al.
Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden
Radiother Oncol
(2011) - et al.
Radiation dose distribution in functional heart regions from tangential breast cancer radiotherapy
Radiother Oncol
(2016)
Dose and fractionation in stereotactic body radiation therapy for stage i non-small cell lung cancer: Lessons learned and where do we go next?
Int J Radiat Oncol Biol Phys
Cardiac atlas development and validation for automatic segmentation of cardiac substructures
Radiother Oncol
Radiation-induced cardiovascular diseases: Is the epidemiologic evidence compatible with the radiobiologic data?
Int J Radiat Oncol Biol Phys
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