TY - JOUR
T1 - Doses of radiation to the pericardium, instead of heart, are significant for survival in patients with non-small cell lung cancer
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)
N1 - Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2019/4
Y1 - 2019/4
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
UR - http://www.scopus.com/inward/record.url?scp=85056222962&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056222962&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2018.10.029
DO - 10.1016/j.radonc.2018.10.029
M3 - Article
C2 - 30416046
AN - SCOPUS:85056222962
SN - 0167-8140
VL - 133
SP - 213
EP - 219
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -