Lung cancer radiotherapy exposes patients to arrhythmia risks based on factors such as dose
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Key takeaways:
- Exposure to radiation during lung cancer treatment may increase future arrhythmia risk.
- Arrhythmia subtype varied by radiation dose and exposed cardiac structure.
Exposure of certain cardiac structures to radiation during treatment of surgically inoperable or unresectable non-small cell lung cancer was associated with increased arrhythmia risk, researchers reported.
The researchers developed an AI model to assist in the segmentation of cardiac structures and function for this analysis of more than 700 patients, which saved “many months of manual work,” Raymond Mak, MD, of the department of radiation oncology at Brigham and Women’s Hospital, said in a press release.
“Radiation exposure to the heart during lung cancer treatment can have very serious and immediate effects on a patient’s cardiovascular health,” Mak said in the release. “We are hoping to inform not only oncologists and cardiologists, but also patients receiving radiation treatment, about the risks to the heart when treating lung cancer tumors with radiation.”
Development of the AI model and study design
For the present study, published in JACC: CardioOncology, Mak and colleagues developed a deep learning model to better understand the association between arrhythmia classes with cardiac substructure radiotherapy dose in patients treated for locally advanced non-small cell lung cancer.
To initially train the model, atrioventricular and sinoatrial nodes of 46 participants from Cedars-Sinai Medical Center were segmented, and patients were divided randomly into training, validation and testing sets.
After training and validation, the researchers used the model to conduct a retrospective analysis including 748 consecutive patients at the Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Dana-Farber Cancer Institute/Brigham and Women’s Hospital at Milford Regional Medical Center treated for locally advanced non-small cell lung cancer with thoracic radiotherapy from 1998 to 2014 (median age, 65 years; 49% women).
All patients included had 2010 American Joint Commission on Cancer clinical stage II or stage III locally advanced non-small cell lung cancer and were treated with 3D conformal or intensity-modulated radiotherapy. Patients treated with stereotactic body radiotherapy were excluded.
Radiation dose and arrhythmia risk
Overall, 17.1% of patients experienced at least one grade 3 or higher arrhythmia (median time to first event, 2 years).
After adjusting for CV risk factors, the researchers estimated risk for the following arrhythmias based on radiation dose to their corresponding cardiac substructures:
- pulmonary vein volume receiving 5 Gy (subdistribution HR [sHR] risk for AF per mL = 1.04; 95% CI, 1.01-1.08; P = .016);
- left circumflex coronary artery volume receiving 35 Gy (sHR for atrial flutter per mL = 1.1; 95% CI, 1.01-1.19; P = .028);
- PV volume receiving 55 Gy (sHR for supraventricular tachyarrhythmia per mL = 1.03; 95% CI, 1.02-1.05; P < .001);
- right coronary artery volume receiving 25 Gy (sHR for bradyarrhythmia per mL = 1.14; 95% CI, 1-1.3; P = .042); and
- left main coronary artery volume receiving 5 Gy (sHR for ventricular tachycardia or asystole per mL = 2.45; 95% CI, 1.21-4.97; P = .013).
“An interesting part of what we did was leverage artificial intelligence algorithms to segment structures like the pulmonary vein and parts of the conduction system to measure the radiation dose exposure in over 700 patients. This saved us many months of manual work,” Mak said in the release. “So, not only does this work have potential clinical impact, but it also opens the door for using AI in radiation oncology research to streamline discovery and create larger datasets.”
Reference:
- Brigham researchers use AI tools to uncover connections between radiotherapy for lung cancer and heart complications. https://www.eurekalert.org/news-releases/1054885. Published Aug. 20, 2024. Accessed Aug. 20, 2024.
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