ArticleRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology2020
Impact of small residual setup errors after image guidance on heart dose and survival in non-small cell lung cancer treated with curative-intent radiotherapy.
Article in Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 15 citations in OpenAlex.
- Radiotherapy-Induced Side Effects: Epidemiology, Pathogenesis, Prevention and Treatments.MedComm · 2026Review
- Impact of respiratory motion on dose to the airways in central and ultra-central lung stereotactic ablative body radiotherapy.Physics and imaging in radiation oncology · 2026Article
- Analysis of setup error and setup efficiency in SBRT for non-small cell lung cancer via a surface-guided radiation therapy system.BMC cancer · 2025Article
- Impact of breast size on dosimetry and radiobiology of VMAT left-sided breast-conserving conventional fractionation radiotherapy under setup errors.Journal of applied clinical medical physics · 2025Article
- Comparative analysis of residual setup errors in head and neck patients from upright versus supine radiotherapy postures.Medical physics · 2025Article
- Radiation-induced cardiac substructure damage and dose constraints: a review.Radiation oncology (London, England) · 2025Review
- Surface-guided radiotherapy improves rotational accuracy in gynecological cancer patients.Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology · 2023Article
- Role of Real-World Data in Assessing Cardiac Toxicity After Lung Cancer Radiotherapy.Frontiers in oncology · 2022Review
- An Institutional Audit of Maximum Heart Dose in Patients Treated With Palliative Radiotherapy for Non-small Cell Lung Cancer.In vivo (Athens, Greece)Article
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Authors and funding
6 authors at 1 institution in 1 country.
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Abstract
background and purposeA recent study of NSCLC patients showed small residual setup errors (shifts) in the direction of the heart following image-guidance were significantly related to overall survival. This study of the dosimetric effects of these residual shifts investigates the hypothesis that observed survival differences were related to a change in heart dose. MATERIALS AND
methodsAccumulated doses including shifts for each fraction were determined for 475 NSCLC patients. Planning CTs and corresponding dose distributions were deformed to a reference. Image-based data-mining techniques were then applied to the difference between the planned and accumulated dose (Δdose) to determine where Δdose relates to 1-year survival. The significance of Δdose in the identified region was assessed using multivariable Cox analysis. The cohort was then split into octiles, based upon planned dose to the region, and multivariable Cox analysis performed for each sub-cohort to explore the dose response relationship. The identified dose threshold for damage was then tested in an independent validation cohort of 1482 NSCLC patients from the same institution.
resultsPermutation testing identified a small region in the heart base where Δdose significantly correlated with 1-year survival. Δdose in this region showed no correlation with common clinical variables, and was significant in multivariable Cox regression (p < 0.001, hazard ratio 1.221/Gy), with increasing change in dose from plan resulting in greater risk of death. Octile analysis revealed Δdose to be significant only in the 7th octile, planning dose 16.2-23.4 Gy, suggesting a steep dose-effect relation for heart damage in this range. Taking 16.2 Gy as a conservative threshold dose, this result was successfully validated, with a significant difference being seen between patients with a region dose above or below 16.2 Gy.
conclusionsThis study suggests the relation between residual set-up errors and survival is explained by changes in cardiac dose, and identifies an area at the heart base where dose is correlated with survival. Our results suggest the dose threshold for cardiac damage is between 16.2 and 23.4 Gy in the base of the heart, which was validated in an independent cohort. However, the dose effect in other regions of the heart should also be investigated.
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