ArticleRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology2024
Cardiac radiation dose is associated with inferior survival but not cardiac events in patients with locally advanced non-small cell lung cancer in the era of immune checkpoint inhibitor consolidation.
Article in Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Dose-volume predictors of cardiac adverse events after high-dose thoracic radiation therapy for lung cancer: a systematic review and meta-analysis.BMC cancer · 2024Pooled it
- AI-surrogate structure and dose correlation for left anterior descending artery in lung stereotactic body radiotherapy.Journal of applied clinical medical physics · 2026Article
- Cardiac substructure dosimetry in thoracic radiotherapy: moving beyond mean heart dose and toward precision cardiac risk mitigation.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026Review
- Heart Substructure Radiation Dose and Cardiac Outcomes: Contemporary Evidence and Actionable Opportunities: JACC CardioOncology State-of-the-Art Review.JACC. CardioOncology · 2026Review
- Cardiac radiosensitivity in the era of thoracic chemoradiotherapy and immunotherapy: a scoping review.The Lancet. Oncology · 2026Article
- Consolidation ICIs Alter cardiac subregion radiosensitivity in NSCLC patients treated with Chemo-Radiotherapy.Clinical and translational radiation oncology · 2026Article
- Radiation-induced cardiac substructure damage and dose constraints: a review.Radiation oncology (London, England) · 2025Review
- Cardiorespiratory-gated cardiac proton radiotherapy using a novel ultrasound guidance system.Clinical and translational radiation oncology · 2025Article
- Correction: Cardiotoxicity following thoracic radiotherapy for lung cancer.British journal of cancer · 2025Article
- Cardiotoxicity following thoracic radiotherapy for lung cancer.British journal of cancer · 2025Review
- Cardiac substructure delineation in radiation therapy - A state-of-the-art review.Journal of medical imaging and radiation oncology · 2024Review
- Dosimetric Planning Comparison for Left Ventricle Avoidance in Non-small Cell Lung Cancer Radiotherapy.Cureus · 2024Article
- Risk Stratification by Combination of Heart and Lung Dose in Locally Advanced Non-Small-Cell Lung Cancer after Radiotherapy.Cancers · 2024Article
- Cardiac volume reduction during radiotherapy in patients with esophageal carcinoma.Molecular and clinical oncology · 2024Article
- Narrative Review: Cardiotoxicities and Cardiac-Sparing Techniques in Radiotherapy.Technology in cancer research & treatmentReview
- Impact of Heart Dose on Survival in Palliative Radiotherapy for Bone Metastases: Propensity Score-matched Analysis.In vivo (Athens, Greece)Article
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Authors and funding
25 authors at 3 institutions in 1 country.
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Abstract
purposeWe assessed the association of cardiac radiation dose with cardiac events and survival post-chemoradiation therapy (CRT) in patients with locally advanced non-small cell lung cancer (LA-NSCLC) after adoption of modern radiation therapy (RT) techniques, stricter cardiac dose constraints, and immune checkpoint inhibitor (ICI) consolidation. METHODS AND MATERIALS: This single-institution, multi-site retrospective study included 335 patients with LA-NSCLC treated with definitive, concurrent CRT between October 2017 and December 2021. All patients were evaluated for ICI consolidation. Planning dose constraints included heart mean dose < 20 Gy (<10 Gy if feasible) and heart volume receiving ≥ 50 Gy (V50Gy) < 25 %. Twenty-one dosimetric parameters for three different cardiac structures (heart, left anterior descending coronary artery [LAD], and left ventricle) were extracted. Primary endpoint was any major adverse cardiac event (MACE) post-CRT, defined as acute coronary syndrome, heart failure, coronary revascularization, or cardiac-related death. Secondary endpoints were: grade ≥ 3 cardiac events (per CTCAE v5.0), overall survival (OS), lung cancer-specific mortality (LCSM), and other-cause mortality (OCM).
resultsMedian age was 68 years, 139 (41 %) had baseline coronary heart disease, and 225 (67 %) received ICI consolidation. Proton therapy was used in 117 (35 %) and intensity-modulated RT in 199 (59 %). Median LAD V15Gy was 1.4 % (IQR 0-22) and median heart mean dose was 8.7 Gy (IQR 4.6-14.4). Median follow-up was 3.3 years. Two-year cumulative incidence of MACE was 9.5 % for all patients and 14.3 % for those with baseline coronary heart disease. Two-year cumulative incidence of grade ≥ 3 cardiac events was 20.4 %. No cardiac dosimetric parameter was associated with an increased risk of MACE or grade ≥ 3 cardiac events. On multivariable analysis, cardiac dose (LAD V15Gy and heart mean dose) was associated with worse OS, driven by an association with LCSM but not OCM.
conclusionsWith modern RT techniques, stricter cardiac dose constraints, and ICI consolidation, cardiac dose was associated with LCSM but not OCM or cardiac events in patients with LA-NSCLC.
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