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dc.contributor.authorBanfill, Kathryn
dc.contributor.authorAbravan, Azadeh
dc.contributor.authorvan Herk, Marcel
dc.contributor.authorSun, F.
dc.contributor.authorFranks, K.
dc.contributor.authorMcWilliam, Alan
dc.contributor.authorFaivre-Finn, Corinne
dc.date.accessioned2022-11-30T10:21:13Z
dc.date.available2022-11-30T10:21:13Z
dc.date.issued2022en
dc.identifier.citationBanfill K, Abravan A, van Herk M, Sun F, Franks K, McWilliam A, et al. Heart dose and cardiac comorbidities influence death with a cardiac cause following hypofractionated radiotherapy for lung cancer. Frontiers in oncology. 2022;12:1007577. PubMed PMID: 36303830. Pubmed Central PMCID: PMC9592751. Epub 2022/10/29. eng.en
dc.identifier.pmid36303830en
dc.identifier.doi10.3389/fonc.2022.1007577en
dc.identifier.urihttp://hdl.handle.net/10541/625746
dc.description.abstractBackground: There is increasing evidence of cardiac toxicity of thoracic radiotherapy however, it is difficult to draw conclusions on cardiac dose constraints due to the heterogeneity of published studies. Moreover, few studies record data on cause of death. The aim of this paper is to investigate the relationship between conventional cardiac dosimetric parameters and death with cardiac causes using data from the UK national cause of death registry. Methods: Data on cancer diagnosis, treatment and cause of death following radical lung cancer radiotherapy were obtained from Public Health England for all patients treated at the Christie NHS Foundation Trust between 1/1/10 and 31/12/16. Individuals with metastatic disease and those who received multiple courses of thoracic radiotherapy where excluded. All patients who received > 45Gy in 20 fractions were included. Cardiac cause of death was defined as the following ICD-10 codes on death certificate: I20-I25; I30-I32; I34-I37; I40-I52. Cardiac V5Gy, V30Gy, V50Gy and mean heart dose (MHD) were extracted. Cumulative incidence of death with cardiac causes were plotted for each cardiac dosimetric parameter. Multi-variable Fine and Gray competing risk analysis was used to model predictors for cardiac death with non-cardiac death as a competing risk. Results: Cardiac dosimetric parameters were available for 967 individuals, 110 died with a cardiac cause (11.4%). Patients with a cardiac comorbidity had an increased risk of death with a cardiac cause compared with those without a cardiac comorbidity (2-year cumulative incidence 21.3% v 6.2%, p<0.001). In patients with a pre-existing cardiac comorbidity, heart V30Gy ≥ 15% was associated with higher cumulative incidence of death with a cardiac cause compared to patients with heart V30Gy <15% (2-year rate 25.8% v 17.3%, p=0.05). In patients without a cardiac comorbidity, after adjusting for tumour and cardiac risk factors, MHD (aHR 1.07, 1.01-1.13, p=0.021), heart V5Gy (aHR 1.01, 1-1.13, p=0.05) and heart V30Gy (aHR 1.04, 1-1.07, p=0.039) were associated with cardiac death. Conclusion: The effect of cardiac radiation dose on cardiac-related death following thoracic radiotherapy is different in patients with and without cardiac comorbidities. Therefore patients' cardiovascular risk factors should be identified and managed alongside radiotherapy for lung cancer.en
dc.language.isoenen
dc.relation.urlhttps://dx.doi.org/10.3389/fonc.2022.1007577en
dc.titleHeart dose and cardiac comorbidities influence death with a cardiac cause following hypofractionated radiotherapy for lung canceren
dc.typeArticleen
dc.contributor.departmentDepartment of Clinical Oncology, The Christie National Health Service (NHS) Foundation Trust, Manchesteren
dc.identifier.journalFrontiers in Oncologyen
dc.description.noteen]
refterms.dateFOA2022-11-30T11:30:38Z


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