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Avoiding cardiac toxicity in patients undergoing curative intent radiotherapy for lung cancer
Banfill, Kathryn Sun, F. McWilliam, Alan Abravan, Azadeh Lilley, J. Wheller, R. Falk, Sally Schmitt, M. Franks, K.
Banfill, Kathryn
Sun, F.
McWilliam, Alan
Abravan, Azadeh
Lilley, J.
Wheller, R.
Falk, Sally
Schmitt, M.
Franks, K.
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Abstract
Introduction: Lung cancer and ischaemic heart disease (IHD) are two
of the five main causes of death in the United Kingdom and about a
quarter of lung cancer patients have concomitant IHD. In the last three
years evidence has emerged that increased heart dose is associated
with poorer survival in patients treated with curative radiotherapy.
Dose to the base of the heart appears to be particularly important,
however cardiac dose volume constraints are not well defined.
Methods: Deformable registration methodology will be applied
retrospectively to 1000 lung cancer patients treated in Leeds with
radical radiotherapy. We will analyse the planning CT data from
the Leeds and Manchester cohorts to quantify coronary artery
calcification using the Agatston score. We will obtain data on cardiac
risk factors, hospital admissions and cause of death for these patients
to conduct a multivariate survival analysis. The prospective trial
aims to recruit 200 patients with a histological or clinical diagnosis
of stage I-III lung cancer suitable for curative intent radiotherapy.
Patients will have blood collected before, on completion of and four
months after RT. Samples will be taken for: full blood count; lipids;
cholesterol; high sensitivity troponin levels; C-reactive protein
and brain natriuretic peptide. Fifty participants in Manchester will
undergo cardiac CT, echocardiogram and 12-lead electrocardiogram
at baseline and 4 months after radiotherapy. The biomarker and
imaging data will be linked to heart dose and survival.
Results: We will validate the correlation between heart dose and
mortality in lung cancer patients treated with radiotherapy using
another centre's dataset. We will obtain prospective data on cardiac
blood biomarkers and imaging. We aim to use both retrospective
and prospective data to derive cardiac dose constraints.
Conclusion: This trial aims to improve the outcomes of lung cancer
patients treated with radical radiotherapy by limiting heart dose
and reducing cardiac events.
Description
Date
2019
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Banfill K, Sun F, McWilliam A, Abravan A, Lilley J, Wheller R, et al. Avoiding cardiac toxicity in patients undergoing curative intent radiotherapy for lung cancer. Lung Cancer. 2019;127:S91-S2.