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• W3094169675 abstract "Cardiotoxicity secondary to radiotherapy (RT) for locally advanced non-small cell lung cancer (LA-NSCLC) is a significant concern in a patient population often presenting with underlying cardiac risk factors. Dose to the heart has been shown to correlate with adverse cardiovascular events (CVEs) following RT. One strategy to minimize heart dose is proton beam RT(PBRT). We sought to test the hypothesis that reduction in heart dose using proton RT would be associated with decreased risk of adverse CVEs in a single-center cohort study. Between December 2008 and November 2016, 202 consecutive patients with LA-NSCLC were treated definitively with chemotherapy and either PBRT or photon RT. Clinical characteristics, RT planning details, and outcomes were collected. We screened for CVEs from our institution’s EMR including myocardial infarction (MI), atrial fibrillation (AFIB), coronary artery disease (CAD), heart failure (HF), stroke (S), and transient ischemic attack (TIA). Associations with these events were calculated by using Fisher's Exact test, and survival by log-rank test from Kaplan-Meier analysis. Ninety-eight patients received proton RT (48.5%) and one hundred four (51.5%) received photon RT. 99.5% of patients received chemotherapy with RT. Median follow up was 29 months (interquartile range, IQR 16-64 mo). The PBRT cohort was significantly older, median age 69.4 years (IQR 65.3-74.7) compared to 63.0 years (IQR 56.3-70.4) (p<0.001) and had a more extensive smoking history (mean 38.8 vs 30.5 pack-years, p = 0.021). Median RT dose received in both groups was 66.6 Gy (range 50.2 – 74.0 Gy). Mean heart dose was significantly lower in the PBRT group (mean 6.7 Gy vs 15.2 Gy, p<0.001) as were heart V5Gy (22.9% vs 46.1%), V30Gy (12.3% vs 21.6%), and V40Gy (9.1% vs 15.3%) (all p <0.001). Prior to the start of RT, CVEs were identified in 46.9% of the proton group (87 events in 46 patients) and 31.7% of the photon group (57 events in 33 patients). After RT, CVEs were recorded in 53.1% of the proton group (108 events in 52 patients) and 47.1% of the photon group (116 events in 49 patients). The type of RT received did not correlate with development of most recorded CVEs. Post-treatment TIA was less common in those receiving PBRT (1.1 % vs 8.2%, p = 0.037). MI was less common in the PBRT cohort (2.3% vs 9.0%), though this did not reach significance (p = 0.06). Overall survival at three years was not significantly different between the groups (38.8% in proton group, 42.1% in photon group, p = 0.99). In our retrospective analysis of definitive treatment of LA-NSCLC, the use of proton RT resulted in reductions in several metrics of heart radiation dose. The proton cohort was significantly older, had a heavier smoking history, and higher pre-treatment burden of CVEs. We observed a correlation with decreased rate of TIA in those receiving proton therapy. However, the type of RT did not correlate with the development of other CVEs, nor did we detect a difference in 3-year survival." @default.
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• W3094169675 date "2020-11-01" @default.
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• W3094169675 title "Cardiac Events Following Radiotherapy for Locally Advanced Non-Small Cell Lung Carcinoma: A Comparison between Photon and Proton Beam Radiotherapy" @default.
• W3094169675 doi "https://doi.org/10.1016/j.ijrobp.2020.07.876" @default.
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