Causal relation between heart irradiation and survival of lung cancer patients after radiotherapy
Authors
Brink, C.Bernchou, U.
Bertelsen, A.
Hansen, O.
Schytte, T.
Hjelmborg, J. V. B.
Holloway, L.
van Herk, Marcel
Johnson-Hart, Corinne
Price, Gareth J
Aznar, Marianne Camille
McWilliam, Alan
Faivre-Finn, Corinne
Hansen, C. R.
Affiliation
Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, DenmarkIssue Date
2022
Metadata
Show full item recordAbstract
Introduction: In a recent study, setup uncertainties in the direction of the heart were shown to impact the overall survival of non-small cell lung cancer (NSCLC) patients after radiotherapy, indicating the causal effect between heart irradiation and survival. The current study aims to externally evaluate this observation within a patient cohort treated using daily IGRT. Method: NSCLC patients with locally-advanced disease and daily CBCT were included. For all treatment fractions, the distance between the isocenter and the heart was evaluated based on the clinical setup registrations. The variation in heart position between planning and treatment (DeltaDistance) was estimated from these registrations. The possible impact of DeltaDistance on survival was analysed by a multivariable Cox model of overall survival, allowing for a time-dependent impact of DeltaDistance to allow for toxicity latency. Results: Daily CBCT information was available for 489 patients at Odense University Hospital. The primary Cox model contained GTV volume, patient age, performance status, and DeltaDistance. DeltaDistance significantly impacted overall survival approximately 50 months after radiotherapy. Subanalyses indicated that the observed effect is mainly present among the patients with the least clinical risk factors. Conclusion: Our results confirm the impact of setup variations in the direction of the heart on the survival of NSCLC patients, even within a cohort using daily CBCT setup guidance. This result indicates a causal effect between heart irradiation and survival. It will be challenging to reduce the setup uncertainty even further; thus, increased focus on dose constraints on the heart seems warrantedCitation
Brink C, Bernchou U, Bertelsen A, Hansen O, Schytte T, Hjelmborg J v.B., et al. Causal relation between heart irradiation and survival of lung cancer patients after radiotherapy. Vol. 172, Radiotherapy and Oncology. Elsevier BV; 2022. p. 126–33.Journal
Radiotherapy and OncologyDOI
10.1016/j.radonc.2022.05.002PubMed ID
35545166Additional Links
https://dx.doi.org/10.1016/j.radonc.2022.05.002Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.1016/j.radonc.2022.05.002
Scopus Count
Collections
Related articles
- Impact of small residual setup errors after image guidance on heart dose and survival in non-small cell lung cancer treated with curative-intent radiotherapy.
- Authors: Johnson-Hart C, Price G, McWilliam A, Green A, Faivre-Finn C, van Herk M
- Issue date: 2020 Nov
- Evaluation of setup accuracy for NSCLC patients; studying the impact of different types of cone-beam CT matches based on whole thorax, columna vertebralis, and GTV.
- Authors: Ottosson W, Baker M, Hedman M, Behrens CF, Sjöström D
- Issue date: 2010 Oct
- Initial report on feasibility of PET/CT-based image-guided moderate hypofractionated thoracic irradiation in node-positive non-small cell lung Cancer patients with poor prognostic factors and strongly diminished lung function: a retrospective analysis.
- Authors: Eze C, Taugner J, Roengvoraphoj O, Schmidt-Hegemann NS, Käsmann L, Wijaya C, Belka C, Manapov F
- Issue date: 2019 Sep 4
- Variations of target volume definition and daily target volume localization in stereotactic body radiotherapy for early-stage non-small cell lung cancer patients under abdominal compression.
- Authors: Han C, Sampath S, Schultheisss TE, Wong JYC
- Issue date: 2017 Summer
- Limited Impact of Setup and Range Uncertainties, Breathing Motion, and Interplay Effects in Robustly Optimized Intensity Modulated Proton Therapy for Stage III Non-small Cell Lung Cancer.
- Authors: Inoue T, Widder J, van Dijk LV, Takegawa H, Koizumi M, Takashina M, Usui K, Kurokawa C, Sugimoto S, Saito AI, Sasai K, Van't Veld AA, Langendijk JA, Korevaar EW
- Issue date: 2016 Nov 1