Increasing Heart Dose Reduces Overall Survival in Patients Undergoing Postoperative Radiation Therapy for NSCLC

Annemarie F. Shepherd, MD; Anthony F. Yu, MD; Michelle Iocolano, MD; Jonathan E. Leeman, MD; Aaron T. Wild, MD; Brandon S. Imber, MD, MA; Jamie E. Chaft, MD; Michael Offin, MD; James Huang, MD; James M. Isbell, MD, MSCI; Abraham J. Wu, MD; Daphna Y. Gelblum, MD; Narek Shaverdian, MD; Charles B. Simone, II, MD; Daniel Gomez, MD; Ellen Yorke, PhD; Andrew Jackson, PhD; Andreas Rimner, MD

JTO Clinical and Research Reports (Aug 2021)

Increasing Heart Dose Reduces Overall Survival in Patients Undergoing Postoperative Radiation Therapy for NSCLC

Annemarie F. Shepherd, MD,
Anthony F. Yu, MD,
Michelle Iocolano, MD,
Jonathan E. Leeman, MD,
Aaron T. Wild, MD,
Brandon S. Imber, MD, MA,
Jamie E. Chaft, MD,
Michael Offin, MD,
James Huang, MD,
James M. Isbell, MD, MSCI,
Abraham J. Wu, MD,
Daphna Y. Gelblum, MD,
Narek Shaverdian, MD,
Charles B. Simone, II, MD,
Daniel Gomez, MD,
Ellen Yorke, PhD,
Andrew Jackson, PhD,
Andreas Rimner, MD

Affiliations

Annemarie F. Shepherd, MD: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York; Corresponding author. Address for correspondence: Annemarie F. Shepherd, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York City, NY 10065.
Anthony F. Yu, MD: Department of Medicine, Cardiology, Memorial Sloan Kettering Cancer Center, New York City, New York
Michelle Iocolano, MD: Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Jonathan E. Leeman, MD: Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
Aaron T. Wild, MD: Southeast Radiation Oncology Group, Levine Cancer Institute, Charlotte, North Carolina
Brandon S. Imber, MD, MA: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
Jamie E. Chaft, MD: Department of Medical Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York City, New York
Michael Offin, MD: Department of Medical Oncology, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York City, New York
James Huang, MD: Department of Surgery, Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York
James M. Isbell, MD, MSCI: Department of Surgery, Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York
Abraham J. Wu, MD: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
Daphna Y. Gelblum, MD: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
Narek Shaverdian, MD: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
Charles B. Simone, II, MD: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
Daniel Gomez, MD: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
Ellen Yorke, PhD: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York
Andrew Jackson, PhD: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York
Andreas Rimner, MD: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York

Journal volume & issue: Vol. 2, no. 8
p. 100209

Abstract

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Introduction: Given the concern for cardiopulmonary toxicity in patients with NSCLC undergoing postoperative radiation therapy (PORT), the purpose of this study was to evaluate the association between heart dose and overall survival (OS) in patients undergoing PORT with modern techniques. Methods: This is a retrospective study of consecutive patients with NSCLC treated with PORT between May 2004 and January 2017. Clinical records were reviewed and radiation dose distributions were analyzed for association with OS. Results: A total of 284 patients were analyzed. At the time of surgery, most patients had pathologic American Joint Committee on Cancer seventh edition stage III disease (91.2 %) and received either preoperative or adjuvant chemotherapy (92.3 %). Most patients underwent a lobectomy (81.3 %) and had R0 (80.6 %) or R1 (19.4 %) resection. PORT was delivered with a median radiation dose of 54 Gy, and 70.4 % of patients were treated with intensity-modulated radiation therapy. Dosimetric variables across a large range of doses to the heart were highly significant (p < 0.05) for OS. The volume of the heart receiving 8 Gy (HV8) was the most significant dosimetric variable (p < 0.001), and the median HV8 was 35.5 %. The median OS was 33.2 versus 53.6 months (p < 0.005) for patients with HV8 above or below 35.5 %, respectively. On multivariable analysis accounting for other potential prognostic confounders, HV8 remained highly significant (p < 0.001). Conclusions: The data reveal a strong correlation between increasing heart dose and OS in patients with NSCLC undergoing PORT. Taken together with the recently presented LungART trial, lowering heart dose in PORT patients may help to decrease the risk of morbidity and mortality and improve the therapeutic ratio of PORT.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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