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    Causal relation between heart irradiation and survival of lung cancer patients after radiotherapy

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    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.
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    Affiliation
    Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Denmark
    Issue Date
    2022
    
    Metadata
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    Abstract
    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 warranted
    Citation
    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 Oncology
    URI
    http://hdl.handle.net/10541/625304
    DOI
    10.1016/j.radonc.2022.05.002
    PubMed ID
    35545166
    Additional Links
    https://dx.doi.org/10.1016/j.radonc.2022.05.002
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.radonc.2022.05.002
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