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

Carsten Brink, Uffe Bernchou, Anders Bertelsen, Olfred Hansen, Tine Schytte, Jacob V B Hjelmborg, Lois Holloway, Marcel van Herk, Corinne Johnson-Hart, Gareth J Price, Marianne C Aznar, Alan McWilliam, Corinne Faivre-Finn, Christian R Hansen

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)126-133
Number of pages8
JournalRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Volume172
Early online date7 May 2022
DOIs
Publication statusPublished - Jul 2022

Keywords

  • Carcinoma, Non-Small-Cell Lung/radiotherapy
  • Humans
  • Lung Neoplasms/radiotherapy
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted/methods
  • Radiotherapy Setup Errors
  • Thorax

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre

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