Identification of dose sensitive cardiac subregions associated with overall survival
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The Division of Cancer Science, The University of Manchester, Manchester, United KingdomIssue Date
2023
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Introduction: The RTOG 0617 trial presented a worse survival for patients with lung cancer treated in the high-dose (74 Gy) arm. In multivariable models, radiation level and whole-heart volumetric dose parameters were associated with survival. In this work, we consider heart subregions to explain the observed survival difference between radiation levels. Methods: Voxel-based analysis identified anatomical regions where the dose was associated with survival. Bootstrapping clinical and dosimetric variables into an elastic net model selected variables associated with survival. Multivariable Cox regression survival models assessed the significance of dose to the heart subregion, compared with whole heart v5 and v30. Finally, the trial outcome was assessed after propensity score matching of patients on lung dose, heart subregion dose, and tumor volume. Results: A total of 458 patients were eligible for voxel-based analysis. A region of significance (p < 0.001) was identified in the base of the heart. Bootstrapping selected mean lung dose, radiation level, log tumor volume, and heart region dose. The multivariable Cox model exhibited dose to the heart region (p = 0.02), and tumor volume (p = 0.03) were significantly associated with survival, and radiation level was not significant (p = 0.07). The models exhibited that whole heart v5 and v30 were not associated with survival, with radiation level being significant (p < 0.05). In the matched cohort, no significant survival difference was seen between radiation levels. Conclusions: Dose to the base of the heart is associated with overall survival, partly removing the radiation level effect, and explaining that worse survival in the high-dose arm is owing, in part, to the heart subregion dose. By defining a heart avoidance region, future dose escalation trials may be feasible.Citation
McWilliam A, Abravan A, Banfil K, Faivre-Finn C, van Herk M. Identification of Dose Sensitive Cardiac Subregions Associated With Overall Survival. Journal of Thoracic Oncology. 2023 May;18(5):599-607. PubMed PMID: WOS:000984197600001.Journal
Journal of Thoracic OncologyDOI
10.1016/j.jtho.2023.01.085PubMed ID
36738929Additional Links
https://dx.doi.org/10.1016/j.jtho.2023.01.085Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.1016/j.jtho.2023.01.085