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Radiation-induced cardiac toxicity and radiation-related coronary artery disease (CAD) represent an important issue in thoracic radiotherapy, although no reliable surrogate biomarkers are identified. The quantification of coronary calcium based on the area of a calcified coronary plaque in a CT slice is called Agatston score, or Coronary Artery Calcification Score (CAC Score) and could represent a potential biomarker for radiation-induced cardiac toxicity. The aim of our work is to evaluate the prevalence and severity of cardiac calcifications in third-stage lung cancer patients before radical chemo-radiotherapy treatment.

Between January 2018 and May 2021, patients with Stage III non-small cell lung cancer (NSCLC) with a pre-treatment CT imaging of the thorax that was discussed in the Multidisciplinary Tumor Board (MTB) of thoracic malignancies in our Department were included. The clinical data of the patients were retrospectively collected (sex, age, smoke exposure, stage) and the Agatston score was calculated on CT imaging and was correlated with the clinical parameters (Chi-Square analysis) and with overall survival (OS, with Kaplan-Meier analysis).

A total of 84 patients were included in the present analysis, , with a median OS of 30 months (mean 34,2 months, 95% CI 28-40 months). The four CAD Score subgroups differed in terms of sex (p:0,010), age (p<0,001) and smoke exposure (p:0,001). The parameters that resulted significantly correlated with a lower OS were the Stage (p<0,001) and the CAD Grading (p:0,001). 

The prevalence of severe CAC Grading is exceedingly high in locally advanced lung cancer patients that are amenable to undergoing different treatments. This subset of patients, independently from the choice of treatment, should be referred to the Cardiologist for prevention and strict follow-up of CAD.