ESTRO 2024 - Abstract Book

S1691

Clinical - Lung

ESTRO 2024

Factors associated with cardiac toxicity after radical radiotherapy in patients with lung cancer

Fariba Tohidinezhad 1 , Leonard Nürnberg 2 , Femke Vaassen 1 , Dennis Bontempi 2 , Rachel Ter Bekke 3 , Lizza Hendriks 4 , Alberto Traverso 5 , Andre Dekker 1 , Dirk De Ruysscher 1 1 Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), Maastricht, Netherlands. 2 Mass General Brigham, Artificial Intelligence in Medicine, Boston, USA. 3 Maastricht University Medical Center, Department of Cardiology, Maastricht, Netherlands. 4 Maastricht University Medical Center, Department of Pulmonary Diseases, Maastricht, Netherlands. 5 Libera Università Vita-Salute San Raffaele, School of Medicine, Milan, Italy

Purpose/Objective:

Given the prolonged overall survival of the patients with lung cancer due to therapeutic advancements, early diagnosis of post-RT cardiac dysfunction is crucial to ensure timely treatment initiation and improve outcomes. The aim of this study was to identify the protective/risk factors associated with the new-onset cardiac events among patients with small or non-small cell lung cancer (SCLC/NSCLC) who received curative photon and/or proton RT.

Material/Methods:

We retrospectively analysed 820 patients (747 NSCLC and 73 SCLC) with stage I-IV lung cancer who received curative photon and/or proton radiotherapy between July 2015 and December 2022. The following clinical variables were selected as candidates for statistical modeling: age, gender, body mass index, tumor specifications (TNM stage, histology, laterality and location), cancer treatments (surgery, chemotherapy and immunotherapy), radiotherapy (modality, prescribed dose, fraction dose and duration), baseline electrocardiography (ECG), lung function tests, laboratory measures (glucose, sodium, potassium, lactate dehydrogenase, C-reactive protein and creatinine), comorbidities (diabetes, hypertension, hyperlipidemia, cardiac, vascular, pulmonary, cerebrovascular, autoimmune and thyroid), substance abuse, medication profile and performance status. Dose-volume measures were calculated for left and right lungs, esophagus, whole heart and its 17 substructures: four chambers, bases of the great vessels: ascending aorta, pulmonary artery, superior vena cava, four coronary arteries: left anterior descending coronary artery, left circumflex artery, left main coronary artery, right coronary artery, heart valves: aortic valve, pulmonary valve, mitral valve, tricuspid valve and conduction nodes: sinoatrial and atrioventricular nodes. All post-RT cardiac evaluations were reviewed to identify new cardiac events. Fine and Gray regression was used to account for competing events.

Results:

Mean age at the time of RT initiation was 69±9 years (range: 26-89); 53% were male, 38% had a cardiovascular medical history. TNM stage was I in 283 (35%), II in 94 (11%), III in 371 (45%) and IV in 72 (8.8%). The tumor was located in the left and right sides in 337 (41%) and 483 (59%) patients, respectively. Tumor resection was performed in 107 (13%) patients prior to RT. Concurrent and sequential chemotherapy was performed in 288 (35%) and 139 (17%) patients, respectively. Chemotherapy regimen was cisplatin-etoposide in 174 (21%), carboplatin-etoposide in 110 (13%) and other in 143 (17%) patients. Stereotactic RT was performed for 221 (27%) patients. Photon, proton and combined RT was performed for 653 (80%), 31 (3.8%) and 136 (17%) patients.