Doses of radiation to the pericardium, instead of heart, are significant for survival in patients with non-small cell lung cancer

Jianxin Xue, Chengbo Han, Andrew Jackson, Chen Hu, Huan Yao, Weili Wang, James Hayman, Weijun Chen, Jianyue Jin, Gregory P. Kalemkerian, Martha Matuzsak, Struti Jolly, Feng Ming (Spring) Kong

Research output: Contribution to journalArticle

Abstract

Background and purpose: Higher cardiac dose was associated with worse overall survival in the RTOG0617 study. Pericardial effusion (PCE) is a common cardiac complication of thoracic radiation therapy (RT). We investigated whether doses of radiation to the heart and pericardium are associated with PCE and overall survival in patients treated with thoracic radiation for non-small cell lung cancer (NSCLC). Materials and methods: A total of 94 patients with medically inoperable/unresectable NSCLC treated with definitive RT in prospective studies were reviewed for this secondary analysis. Heart and pericardium were contoured consistently according to the RTOG1106 Atlas, with the great vessels and thymus of the upper mediastinal structures included in the upper part of pericardium, only heart chambers included in the heart structure. Clinical factors and dose–volume parameters associated with PCE or survival were identified via Cox proportional hazards modeling. The risk of PCE and death were mapped using DVH atlases. Results: Median follow-up for surviving patients was 58 months. The overall rate of PCE was 40.4%. On multivariable analysis, dosimetric factors of heart and pericardium were significantly associated with the risk of PCE. Pericardial V30 and V55 were significantly correlated with overall survival, but presence of PCE and heart dosimetric factors were not. Conclusion: PCE was associated with both heart and pericardial doses. The significance of pericardial dosimetric parameters, but not heart chamber parameters, on survival suggests the potential significance of radiation damage to the cranial region of pericardium.

Original languageEnglish (US)
Pages (from-to)213-219
Number of pages7
JournalRadiotherapy and Oncology
Volume133
DOIs
StatePublished - Apr 1 2019

Fingerprint

Pericardial Effusion
Pericardium
Non-Small Cell Lung Carcinoma
Radiation
Survival
Atlases
Radiotherapy
Thorax
Thymus Gland
Prospective Studies

Keywords

  • Heart dose
  • NSCLC
  • Pericardial dose
  • Pericardial effusion

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Doses of radiation to the pericardium, instead of heart, are significant for survival in patients with non-small cell lung cancer. / Xue, Jianxin; Han, Chengbo; Jackson, Andrew; Hu, Chen; Yao, Huan; Wang, Weili; Hayman, James; Chen, Weijun; Jin, Jianyue; Kalemkerian, Gregory P.; Matuzsak, Martha; Jolly, Struti; Kong, Feng Ming (Spring).

In: Radiotherapy and Oncology, Vol. 133, 01.04.2019, p. 213-219.

Research output: Contribution to journalArticle

Xue, J, Han, C, Jackson, A, Hu, C, Yao, H, Wang, W, Hayman, J, Chen, W, Jin, J, Kalemkerian, GP, Matuzsak, M, Jolly, S & Kong, FMS 2019, 'Doses of radiation to the pericardium, instead of heart, are significant for survival in patients with non-small cell lung cancer', Radiotherapy and Oncology, vol. 133, pp. 213-219. https://doi.org/10.1016/j.radonc.2018.10.029
Xue, Jianxin ; Han, Chengbo ; Jackson, Andrew ; Hu, Chen ; Yao, Huan ; Wang, Weili ; Hayman, James ; Chen, Weijun ; Jin, Jianyue ; Kalemkerian, Gregory P. ; Matuzsak, Martha ; Jolly, Struti ; Kong, Feng Ming (Spring). / Doses of radiation to the pericardium, instead of heart, are significant for survival in patients with non-small cell lung cancer. In: Radiotherapy and Oncology. 2019 ; Vol. 133. pp. 213-219.
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abstract = "Background and purpose: Higher cardiac dose was associated with worse overall survival in the RTOG0617 study. Pericardial effusion (PCE) is a common cardiac complication of thoracic radiation therapy (RT). We investigated whether doses of radiation to the heart and pericardium are associated with PCE and overall survival in patients treated with thoracic radiation for non-small cell lung cancer (NSCLC). Materials and methods: A total of 94 patients with medically inoperable/unresectable NSCLC treated with definitive RT in prospective studies were reviewed for this secondary analysis. Heart and pericardium were contoured consistently according to the RTOG1106 Atlas, with the great vessels and thymus of the upper mediastinal structures included in the upper part of pericardium, only heart chambers included in the heart structure. Clinical factors and dose–volume parameters associated with PCE or survival were identified via Cox proportional hazards modeling. The risk of PCE and death were mapped using DVH atlases. Results: Median follow-up for surviving patients was 58 months. The overall rate of PCE was 40.4{\%}. On multivariable analysis, dosimetric factors of heart and pericardium were significantly associated with the risk of PCE. Pericardial V30 and V55 were significantly correlated with overall survival, but presence of PCE and heart dosimetric factors were not. Conclusion: PCE was associated with both heart and pericardial doses. The significance of pericardial dosimetric parameters, but not heart chamber parameters, on survival suggests the potential significance of radiation damage to the cranial region of pericardium.",
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AU - Xue, Jianxin

AU - Han, Chengbo

AU - Jackson, Andrew

AU - Hu, Chen

AU - Yao, Huan

AU - Wang, Weili

AU - Hayman, James

AU - Chen, Weijun

AU - Jin, Jianyue

AU - Kalemkerian, Gregory P.

AU - Matuzsak, Martha

AU - Jolly, Struti

AU - Kong, Feng Ming (Spring)

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background and purpose: Higher cardiac dose was associated with worse overall survival in the RTOG0617 study. Pericardial effusion (PCE) is a common cardiac complication of thoracic radiation therapy (RT). We investigated whether doses of radiation to the heart and pericardium are associated with PCE and overall survival in patients treated with thoracic radiation for non-small cell lung cancer (NSCLC). Materials and methods: A total of 94 patients with medically inoperable/unresectable NSCLC treated with definitive RT in prospective studies were reviewed for this secondary analysis. Heart and pericardium were contoured consistently according to the RTOG1106 Atlas, with the great vessels and thymus of the upper mediastinal structures included in the upper part of pericardium, only heart chambers included in the heart structure. Clinical factors and dose–volume parameters associated with PCE or survival were identified via Cox proportional hazards modeling. The risk of PCE and death were mapped using DVH atlases. Results: Median follow-up for surviving patients was 58 months. The overall rate of PCE was 40.4%. On multivariable analysis, dosimetric factors of heart and pericardium were significantly associated with the risk of PCE. Pericardial V30 and V55 were significantly correlated with overall survival, but presence of PCE and heart dosimetric factors were not. Conclusion: PCE was associated with both heart and pericardial doses. The significance of pericardial dosimetric parameters, but not heart chamber parameters, on survival suggests the potential significance of radiation damage to the cranial region of pericardium.

AB - Background and purpose: Higher cardiac dose was associated with worse overall survival in the RTOG0617 study. Pericardial effusion (PCE) is a common cardiac complication of thoracic radiation therapy (RT). We investigated whether doses of radiation to the heart and pericardium are associated with PCE and overall survival in patients treated with thoracic radiation for non-small cell lung cancer (NSCLC). Materials and methods: A total of 94 patients with medically inoperable/unresectable NSCLC treated with definitive RT in prospective studies were reviewed for this secondary analysis. Heart and pericardium were contoured consistently according to the RTOG1106 Atlas, with the great vessels and thymus of the upper mediastinal structures included in the upper part of pericardium, only heart chambers included in the heart structure. Clinical factors and dose–volume parameters associated with PCE or survival were identified via Cox proportional hazards modeling. The risk of PCE and death were mapped using DVH atlases. Results: Median follow-up for surviving patients was 58 months. The overall rate of PCE was 40.4%. On multivariable analysis, dosimetric factors of heart and pericardium were significantly associated with the risk of PCE. Pericardial V30 and V55 were significantly correlated with overall survival, but presence of PCE and heart dosimetric factors were not. Conclusion: PCE was associated with both heart and pericardial doses. The significance of pericardial dosimetric parameters, but not heart chamber parameters, on survival suggests the potential significance of radiation damage to the cranial region of pericardium.

KW - Heart dose

KW - NSCLC

KW - Pericardial dose

KW - Pericardial effusion

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