Cardiovascular Toxicity in Patients Treated With Radiotherapy for Lung Cancer
Posted: Monday, July 8, 2019
According to research published in the Journal of the American College of Cardiology, patients with locally advanced non–small cell lung cancer (NSCLC) who receive high doses of heart radiation exposure are at increased risk for major adverse cardiac events and all-cause mortality. Although heart radiation exposure typically has a prolonged latency to cardiotoxicity, improved survival rates for patients with lung cancer have resulted in more radiation-related major adverse cardiac events, including heart attack and heart failure.
“These cardiac events are happening earlier and more often than previously thought,” stated Raymond Mak, MD, of Brigham and Dana-Farber Cancer Institute, in a press release. “Despite the competing risk of cancer-specific death in locally advanced NSCLC patients, cardiac radiation dose exposure is a modifiable cardiac risk factor for major adverse cardiac events and all-cause mortality, supporting the need for early recognition and treatment of cardiovascular events and more stringent avoidance of high cardiac radiotherapy dose,” the investigators concluded.
The retrospective study included 748 patients with locally advanced NSCLC who had been treated with thoracic radiotherapy. At a median follow-up of 20.4 months, 533 deaths had occurred, and 77 patients (10.3%) had experienced at least one major adverse cardiac event (2-year cumulative incidence = 5.8%). An increased risk of major adverse cardiac events as well as all-cause mortality was associated with the mean radiation dose delivered to the heart (≥ 10 Gy vs. < 10 Gy).
The increased risk of all-cause mortality associated with the mean heart radiation dose also included patients without preexisting coronary heart disease (178 vs. 118 deaths; HR = 1.34). However, this risk did not extend to patients who had coronary heart disease prior to radiation therapy (112 vs. 82 deaths; HR = 0.94).
Disclosure: The study authors’ disclosure information may be found at onlinejacc.org.