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Cardiac events common after radiotherapy in NSCLC
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Cardiac events were “relatively common” among patients who received high-dose thoracic radiotherapy for stage III non–small cell lung cancer, according to findings published in Journal of Clinical Oncology.
Cardiac toxicity from radiotherapy may occur earlier than previously thought, researchers wrote.
“Radiotherapy-associated heart toxicity has long been recognized in patients with breast cancer or Hodgkin lymphoma, with increases in cardiovascular events and deaths typically noted 10 or more years after treatment,” Kyle Wang, MD, radiation oncology resident at UNC School of Medicine, and colleagues wrote. “However, the clinical relevance of radiotherapy-associated heart disease for patients with stage III NSCLC is unclear.”
Wang and colleagues conducted a pooled analysis of six phase 1 and phase 2 trials, performed between 1996 and 2009, of escalating radiotherapy doses ranging from 70 Gy to 90 Gy in 112 patients. The researchers reviewed patient records for symptomatic cardiac events and assessed cardiac risk by identifying baseline coronary artery disease and calculating WHO/International Society of Hypertension scores.
Median follow-up was 8.8 years among surviving patients.
Twenty-three percent of patients (n = 26) experienced at least one cardiac event at a median 26 months. Cardiac events included arrhythmia (n = 12), effusion (n = 7), myocardial infarction (n = 5), unstable angina (n = 3), pericarditis (n = 2) and heart failure (n = 1).
Univariable analysis indicated that heart doses (P = .002), WHO/International Society of Hypertension score (P = .04) and coronary artery disease (P < .001), were associated with cardiac events. Heart doses remained significant after multivariable analysis to account for baseline risk.
The 2-year competing risk-adjusted event rate was 4% for patients with a mean heart dose less than 10 Gy, 7% for mean heart dose 10 Gy to less than 20 Gy and 21% for 20 Gy or greater.
Heart doses were not associated with OS.
“Clinically significant cardiac events after high-dose thoracic radiotherapy for stage III NSCLC were associated with heart dose and cardiac risk and occurred fairly early after treatment,” the researchers wrote. “Consistent with the … emphasis on reducing radiation heart exposure for other malignancies, heart doses should be similarly minimized in patients with stage III NSCLC.” – by Andy Polhamus
Disclosure: Wang reports no relevant financial disclosures. Please see the study for a full list of all other researchers’ relevant financial disclosures.
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