ESTRO 2023

Session Item

Lung

Session Type: Poster (Digital)

Track: Clinical

Journey:

Early cardiac toxicity in stage III non-small cell lung cancer: preliminary dosimetric analysis

Edy Ippolito, Italy

Presentation Number: PO-1322

Abstract

Abstract Title:

Early cardiac toxicity in stage III non-small cell lung cancer: preliminary dosimetric analysis

Authors:

Marianna Miele¹, Edy Ippolito², Michele Fiore³, Carlo Greco³, Martina Benincasa⁴, Miriam Carpenito⁵, Simona Mega⁵, Francesco Grigioni⁶, Sara Ramella³

¹Operative Research Unit of Radiation Oncology, Campus Bio-Medico University Hospital Foundation, Unit Of Radiation Oncology, Rome, Italy; ²Research Unit of Radiation Oncology, Department of Medicine and Surgery, University of Campus Bio-Medico of Rome, Unit of Radiation Oncology,, Rome, Italy; ³Research Unit of Radiation Oncology, Department of Medicine and Surgery, University of Campus Bio-Medico of Rome, Unit of Radiation Oncology, Rome, Italy; ⁴Operative Research Unit of Radiation Oncology, University of Campus Bio-Medico of Rome, Unit of Radiation Oncology, Rome, Italy; ⁵Operative Research Unit of Cardiology, University of Campus Bio-Medico of Rome, Unit of Cardiology, Rome, Italy; ⁶Research Unit of Cardiology Department of Medicine and Surgery, University of Campus Bio-Medico of Rome, Unit of Cardiology, Rome, Italy

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Purpose or Objective

The aim of this study was to prospectively investigate a correlation between the heart dosimetry and early heart damage in patients with locally advanced non small cell lung cancer (LA-NSCLC) undergoing chemoradiotherapy (CRT).

Material and Methods

This trial is a prospective, observational cohort study including patients with stage IIIA-IIIB NSCLC who underwent concomitant chemoradiotherapy (CRT). Radiotherapy was delivered with a median total dose of 60 Gy with conventional fractionation. The 3D techinique or Intesity-modulated radiotherapy (IMRT) was used. Manual contouring of target and organs at risk (OAR) was performed from the simulation CT images. The difference in cardiac dosimetry in patients who have experienced cardiac and no-cardiac events (CV) was assessed by T-Test. Subsequently, dosimetric parameters that resulted different between patients who experienced CV and patients who did not, were subjected to regression analysis.

Results

This preliminary analysis included thirty-four patients with stage IIIA-IIIB NSCLC. The median age was 69.5 years (range, 43-87). The median follow-up was 27.8 months. 62% of patients were in stage IIIA. All patients were treated with concurrent CRT and in 65% of cases a platinum-based regimen was used. No patients died of CV complications. Eight patients (23.5%) had a CV event: four atrial fibrillation, two supraventricular tachycardia, one atrioventricular block (second degree), and one patient presented heart failure. The cardiac dosimetric parameters analyzed were described in Table 1. The analysis of cardiac dosimetry was shown in Table 2. Patients who developed CV and no-CV have higher mean values of PTV volume (442 vs 310 p=0.031), heartDmean (17.72 vs 11.89 p=0.032), V30 (24 vs 13 p=0.009), V45 (10.79 vs 5.68 p=0.007), V50 (7 vs 3.85 p=0.030), resulting all in prediction of CV events. In particular, PTV volume (AUC 0.75), HeartDmean (AUC 0.73), V30 (AUC=0.76), V45 (AUC=0.79) and V50 (AUC=0.72) were significant.

Conclusion

This preliminary data have shown that all parameters evaluated, except of left anterior descending artery (LAD) dose, were found to be predictive of cardiovascular damage after CRT. These results encourage us to continue the study in order to estimate the overall and individual incidence of any early cardiac event and to identify additional variables that cause an increased risk of acute cardiac events.