File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Cardiac events after radiation therapy: Combined analysis of prospective multicenter trials for locally advanced non-small-cell lung cancer

TitleCardiac events after radiation therapy: Combined analysis of prospective multicenter trials for locally advanced non-small-cell lung cancer
Authors
Issue Date2017
Citation
Journal of Clinical Oncology, 2017, v. 35, n. 13, p. 1395-1402 How to Cite?
Abstract© 2017 by American Society of Clinical Oncology. Purpose: Radiation therapy is a critical component in the care of patients with non-small-cell lung cancer (NSCLC), yet cardiac injury after treatment is a significant concern. Therefore, we wished to elucidate the incidence of cardiac events and their relationship to radiation dose to the heart. Patients and Materials: Study eligibility criteria included patients with stage II to III NSCLC treated on one of four prospective radiation therapy trials at two centers from 2004 to 2013. All cardiac events were reviewed and graded per Common Terminology Criteria for Adverse Events (v4.03). The primary end point was the development of a grade ≥ 3 cardiac event. Results: In all, 125 patients met eligibility criteria; median follow-up was 51 months for surviving patients. Median prescription dose was 70 Gy, 84% received concurrent chemotherapy, and 27% had preexisting cardiac disease. Nineteen patients had a grade ≥ 3 cardiac event at a median of 11 months (interquartile range, 6 to 24 months), and 24-month cumulative incidence was 11% (95% CI, 5% to 16%). On multivariable analysis (MVA), pre-existing cardiac disease (hazard ratio [HR], 2.96; 95% CI, 1.07 to 8.21; P = .04) and mean heart dose (HR, 1.07/Gy; 95% CI, 1.02 to 1.13/Gy; P = .01) were significantly associated with grade ≥ 3 cardiac events. Analyzed as time-dependent variables on MVA analysis, both disease progression (HR, 2.15; 95% CI, 1.54 to 3.00) and grade ≥ 3 cardiac events (HR, 1.76; 95% CI, 1.04 to 2.99) were associated with decreased overall survival. However, disease progression (n = 71) was more common than grade ≥ 3 cardiac events (n = 19). Conclusion: The 24-month cumulative incidence of grade ≥ 3 cardiac events exceeded 10% among patients with locally advanced NSCLC treated with definitive radiation. Pre-existing cardiac disease and higher mean heart dose were significantly associated with higher cardiac event rates. Caution should be used with cardiac dose to minimize risk of radiation-associated injury. However, cardiac risks should be balanced against tumor control, given the unfavorable prognosis associated with disease progression.
Persistent Identifierhttp://hdl.handle.net/10722/266789
ISSN
2020 Impact Factor: 44.544
2020 SCImago Journal Rankings: 10.482
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorDess, Robert T.-
dc.contributor.authorSun, Yilun-
dc.contributor.authorMatuszak, Martha M.-
dc.contributor.authorSun, Grace-
dc.contributor.authorSoni, Payal D.-
dc.contributor.authorBazzi, Latifa-
dc.contributor.authorMurthy, Venkatesh L.-
dc.contributor.authorHearn, Jason W.D.-
dc.contributor.authorKong, Feng Ming-
dc.contributor.authorKalemkerian, Gregory P.-
dc.contributor.authorHayman, James A.-
dc.contributor.authorTen Haken, Randall K.-
dc.contributor.authorLawrence, Theodore S.-
dc.contributor.authorSchipper, Matthew J.-
dc.contributor.authorJolly, Shruti-
dc.date.accessioned2019-01-31T07:19:35Z-
dc.date.available2019-01-31T07:19:35Z-
dc.date.issued2017-
dc.identifier.citationJournal of Clinical Oncology, 2017, v. 35, n. 13, p. 1395-1402-
dc.identifier.issn0732-183X-
dc.identifier.urihttp://hdl.handle.net/10722/266789-
dc.description.abstract© 2017 by American Society of Clinical Oncology. Purpose: Radiation therapy is a critical component in the care of patients with non-small-cell lung cancer (NSCLC), yet cardiac injury after treatment is a significant concern. Therefore, we wished to elucidate the incidence of cardiac events and their relationship to radiation dose to the heart. Patients and Materials: Study eligibility criteria included patients with stage II to III NSCLC treated on one of four prospective radiation therapy trials at two centers from 2004 to 2013. All cardiac events were reviewed and graded per Common Terminology Criteria for Adverse Events (v4.03). The primary end point was the development of a grade ≥ 3 cardiac event. Results: In all, 125 patients met eligibility criteria; median follow-up was 51 months for surviving patients. Median prescription dose was 70 Gy, 84% received concurrent chemotherapy, and 27% had preexisting cardiac disease. Nineteen patients had a grade ≥ 3 cardiac event at a median of 11 months (interquartile range, 6 to 24 months), and 24-month cumulative incidence was 11% (95% CI, 5% to 16%). On multivariable analysis (MVA), pre-existing cardiac disease (hazard ratio [HR], 2.96; 95% CI, 1.07 to 8.21; P = .04) and mean heart dose (HR, 1.07/Gy; 95% CI, 1.02 to 1.13/Gy; P = .01) were significantly associated with grade ≥ 3 cardiac events. Analyzed as time-dependent variables on MVA analysis, both disease progression (HR, 2.15; 95% CI, 1.54 to 3.00) and grade ≥ 3 cardiac events (HR, 1.76; 95% CI, 1.04 to 2.99) were associated with decreased overall survival. However, disease progression (n = 71) was more common than grade ≥ 3 cardiac events (n = 19). Conclusion: The 24-month cumulative incidence of grade ≥ 3 cardiac events exceeded 10% among patients with locally advanced NSCLC treated with definitive radiation. Pre-existing cardiac disease and higher mean heart dose were significantly associated with higher cardiac event rates. Caution should be used with cardiac dose to minimize risk of radiation-associated injury. However, cardiac risks should be balanced against tumor control, given the unfavorable prognosis associated with disease progression.-
dc.languageeng-
dc.relation.ispartofJournal of Clinical Oncology-
dc.titleCardiac events after radiation therapy: Combined analysis of prospective multicenter trials for locally advanced non-small-cell lung cancer-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1200/JCO.2016.71.6142-
dc.identifier.pmid28301264-
dc.identifier.scopuseid_2-s2.0-85018346472-
dc.identifier.volume35-
dc.identifier.issue13-
dc.identifier.spage1395-
dc.identifier.epage1402-
dc.identifier.eissn1527-7755-
dc.identifier.isiWOS:000400335500004-
dc.identifier.issnl0732-183X-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats