ESTRO 2024 - Abstract Book

S1717

Clinical - Lung

ESTRO 2024

A bespoke questionnaire was designed as no survey tools have been published previously. Questions were initially drafted following an extensive review of the literature and from recurring themes presented at radiation oncology and cardio-oncology research meetings. Six question domains were retained following consensus discussions among the investigators, comprising 55 multiple choice stems: guidelines, cardiovascular assessment, cardiology investigations, radiotherapy planning strategies, primary prevention prescribing and local cardio-oncology service access. An invitation was sent to all radiation oncologists registered with ICOS, and the investigators also circulated a standardised email invitation to colleagues by email and on X. Ethical approval was granted by Queen’s University Belfast.

Results:

In total 118, participants were recruited (Europe 67, North American 18, Asia 13, Australia 9, South America 8, Africa 2, unknown 1). Most participants were attending/consultant physicians with more than a decade of experience at this level (54%), or less than 10 years (38%), and a small number of residents/registrars participated (7%). The JACC Cardio-Oncology 2021 review article (Bergom 2021) was rated as the most useful paper, followed by the joint ESC – ESTRO guideline (Lyon 2022). The majority of participants indicated that ascertaining a detailed cardiovascular history (80%) and calculation of a cardiovascular risk score (e.g. SCORE2 or QRISK3) at baseline (51%) were important. Opinions on the difficulty of introducing a proforma were mostly split between minimally (46%) and very/quite (42%) difficult. In terms of routine baseline investigations, cardiometabolic blood tests (eg. HbA1c, lipids) had the greatest degree of perceived importance (48%), followed by electrocardiograms (ECGs) (45%) ( Figure 1 ). There was less support for echocardiograms (40%) and troponin/BNP (both 19%). In the context of cardiac monitoring during the post-radiotherapy follow-up period, some participants perceived ECG (32%) and echocardiogram (33%) to be important, but support for routine troponin (12%) and BNP (15%) was low.

Importance of availability of cardiac substructure auto-segmentation was deemed to be very/quite important by the majority (69%) and incorporating substructure dose constraints was rated similarly (65%). The most common substructure dose constraint employed is the left anterior descending coronary artery volume receiving 15Gy (LAD V15), with 29% centres routinely applying the recommended dose constraint of <15%. The heart base region (16%) and sinoatrial node (12%) have been implemented by fewer physicians, and more plan to implement the heart base (38%) than the sinoatrial node (31%). Adjusting cardiac dose constraints by clinical cardiovascular risk was deemed to be very/quite important by 58% but using coronary artery calcium on planning scans was less so (32%).