NSCLC: lower cardiac dose constraints needed for radiation treatment

  • Dess RT & al.
  • Pract Radiat Oncol
  • 02.08.2019

  • von Craig Hicks
  • Studien – kurz & knapp
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Takeaway

  • One-quarter of patients undergoing radiation treatment for locally advanced NSCLC receive a mean heart dose exceeding 20 Gy, a level linked to cardiac event rates ≥20% at 2 years.

Why this matters

  • Ionizing radiation dose to the heart during NSCLC treatment is strongly associated with inferior survival; treatment approaches are needed that meet dose constraints without compromising disease management goals.

Study design

  • Researchers studied patients with stage 3 NSCLC treated with radiation within a statewide consortium of 22 oncology clinics (N=746; mean age, 67 years; 54% men; left-sided primary disease, 38%; N2/N3 disease, 80%).
  • They surveyed sites within the consortium to assess established dose constraints.
  • Funding: Blue Cross Blue Shield of Michigan; Blue Care Network.

Key results

  • Median mean heart dose was 12 Gy (interquartile range, 5-19 Gy).
  • Percentage of heart volume exceeding a 30-Gy dose threshold (V30Gy) was >50% in 5% of cases; V40Gy was >35% in 3% of cases.
  • 16 (89%) of 18 responding clinics used cardiac dose constraints, but none was consistently applied across the consortium.
  • V30Gy was the most common dose level, used by 80% of clinics; the most common threshold was V30Gy≤50%.
  • No clinic used low dose constraints (

Limitations

  • Lack of cardiac morbidity, cardiac mortality, and overall survival outcomes preclude strong recommendations on specific dose constraints.