Major Adverse Cardiac Events After Radiation Therapy in Lung Cancer

Authors

  • Ramsey Omari Indiana University School of Medicine https://orcid.org/0000-0002-7697-5248
  • Charles Curtis Department of Radiation Oncology, Indiana University School of Medicine
  • Nichole Burket Marian University College of Osteopathic Medicine, Indianapolis
  • Michael Weisman Department of Radiation Oncology, Indiana University School of Medicine
  • Xiaofeng Chen Department of Radiation Oncology, Indiana University School of Medicine
  • Tim Lautenschlaeger, MD Department of Radiation Oncology, Indiana University School of Medicine

DOI:

https://doi.org/10.18060/25761

Abstract

Motivation: 

Receiving radiation to the heart has been recognized as a risk factor for the development of major adverse cardiovascular events (MACEs) for many years. However, recent data suggests that radiation dosing to substructures of the heart serve as a better surrogate for evaluating the risk of developing a MACE than whole heart radiation dose. Recent papers suggest that dosing to the left anterior descending artery (LAD) can be used as a robust marker for cardiotoxicity risk; however, this association lacks corroborative data and is currently not incorporated into clinically routine care. 

Problem: 

In this paper we seek to investigate the relationship between radiation dose to the LAD and risk of developing a MACE in lung cancer patients treated with curative intent radiation. 

Approach: 

Chart review to confirm the presence of MACE events was performed in patients who were identified based on elevated troponin values to potentially have had a MACE after receiving their last dose of radiation therapy. Patients who had multiple courses of radiation therapy separated in time (>60 days) that received greater than 0.2 Gy whole heart dose during their subsequent courses before having a MACE were excluded. Selected patients were then stratified based on presence cardiovascular co-morbidities. Contours of patient’s LADs were made after patient selection, and will be verified by an expert (e.g., cardiologist or thoracic radiologist). 

Results: 

Dose to the LAD will be calculated and an assessment of the correlation between radiation dose and risk of having a MACE will be made. Analysis will assess the cardiac event rate at various times as well as time to MACE. 

Implications: 

This paper can help set a quantifiable standard with which radiation oncologists can use to minimize their patient’s risk of developing a MACE by minimizing radiation dosing to specific cardiac substructures while maintaining tumor coverage. 

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Published

2021-12-10

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Abstracts