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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.17-02 - Cardiopulmonary Exercise Tests in Lung Cancer Patients Treated Radical Radiotherapy and Chemotherapy – Feasibility Study (ID 14145)

      16:45 - 18:00  |  Presenting Author(s): Nazia Mohammed

      • Abstract
      • Slides

      Background

      Cardiopulmonary exercise testing (CPET) is based on the principle that system failure can be detected when the system is under stress. CPET allows measurement of peak oxygen consumption (peak VO2), the gold standard measure of exercise performance, and can identify the causes of exercise limitation. Variables measured at CPET can predict mortality in various disease states and is used to assess fitness for surgery. Lung cancer patients often have pre-existing cardiopulmonary disease, however there is limited data on the role of CPET in patients treated with radical radiotherapy (RRT). Recent RTOG 0617 study reported worse survival with RRT dose escalation, which was attributed to cardiopulmonary toxicity. This study aimed to investigate the feasibility of using CPET to study the effects of RRT on exercise capacity and to assess its cardiac and pulmonary components.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      During the period 2003 – 2009, NSCLC patients undergoing RRT consented to participate in this prospective study. Alongside standard incremental CPETs, patients were assessed with pulmonary function tests and standardized measure of activity of daily living, the London Chest Activity of Daily Living scale (LCADL) at four different time points: pre-RRT and at 6 weeks, 6 months and 12 months post RRT.

      4c3880bb027f159e801041b1021e88e8 Result

      Thirty-eight patients participated. Median age was 66 years, and Karnofsky Performance Status >70. Using TNM 5th Edition, staging was T1-2/T3-4 = 50%/50%, N0-X/N1-2 = 50%/50% and M0/1 = 92%/8%. Planned RRT was completed by 34 pts.

      Over the 12 months the peak VO2 (l/min) decreased (p overall = 0.009) from a median 0.83 by a maximum of 0.12 at 6 m, thus demonstrating a decline in exercise performance.

      The VE/CO2AT increased (p overall = 0.005) post RT from a median 40, most clearly at 3 months (5, p=.028). Furthermore peak alveolar-arterial (A-a) gradient increased (p overall =.001) from a baseline median value of 38.5 at 6w (3.15, p=.046) and 3m (5.75, p=.013) respectively. These results indicate a decline in ventilatory efficiency following RRT.

      No significant changes were seen in oxygen pulse, a surrogate measure of cardiac function.

      LCADL completion reduced after 6w. The median baseline score was 22 and a statistically significant difference could not be detected over time (p overall = 0.502)

      8eea62084ca7e541d918e823422bd82e Conclusion

      The results indicate that CPET is able to detect a decline in exercise performance after RRT and that in this study the decline appears to be driven by a reduction in respiratory function. These results require confirmation in a larger study.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P2.17-22 - Cardiac Biomarkers in CART Study (CARdiac Toxicity in Lung Cancer Patients After Chemo-Radiotherapy). (ID 14165)

      16:45 - 18:00  |  Presenting Author(s): Nazia Mohammed

      • Abstract
      • Slides

      Background

      Lung cancer has the highest incidence and mortality. Chemo-radiation (CRT) can achieve curative outcomes, but there is limited knowledge of the associated toxicity. The results of the RTOG 0617 study highlighted the impact of cardiac toxicity. Further investigation of cardiopulmonary toxicity is required.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      This is a single centre, prospective observational study in which NSCLC patients undergoing RRT with or without chemotherapy were invited to participate. Evaluations include clinical assessment, cardiac MRI and ECG. Biomarker results are available for lattermost patients. Evaluations performed at baseline, during treatment, 6 weeks and 6 months after treatment.

      4c3880bb027f159e801041b1021e88e8 Result

      11 patients underwent translational blood sampling. Key details are given in table 1. Change in biomarker results is shown in figure 1. In this limited sample the change did not reach statistical significance. This study showed that 3/11 patients achieved hsTnT > 14 (suggestive of myocardial damage) during study period. 8/11 patients had NTproBNP > 125 (suggestive of increased heart failure risk) at some point on study. 3/11 demonstrated an NTproBNP levels > 400, a recognised cut off warranting cardiac echo.

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      Table 1

      Patient

      Baseline

      Co-morbidities

      Baseline ECG result

      Treatment

      Baseline NTproBNP, pg/ml

      (maximum change post-baseline)

      Baseline hsTnT, pg/ml

      (maximum change post-baseline)

      Hospital admission within 6 months (reason)

      Status at 6 months

      22

      Normal

      RRT

      22

      (+ 4%)

      6.7

      (+38%)

      No

      Alive

      24

      IHD, DM, COPD, RA

      T-inversion, II, III, aVF

      CRT

      625

      (+101%)

      11.2

      (+105%)

      Yes (COPD, NSTEMI)

      Alive

      26

      Normal

      CRT

      89

      (+79%)

      6.2

      (+67%)

      Yes (Chest pain)

      Alive

      27

      CHOLES, HPT

      Normal

      RRT

      81

      (+80%)

      5.5

      (+47%)

      Yes (Unknown)

      Alive

      28

      HPT

      Normal

      RRT

      32

      (+106%)

      7.1

      (-20%)

      No

      Alive

      29

      IHD, DM, CHOLES

      Sinus Bradycardia,

      Ist Degree AV Block

      RRT

      Missing

      (NA)

      Missing

      (NA)

      No

      Alive

      30

      COPD, HEPB

      Sinus Bradycardia

      CRT

      113

      (+148%)

      7.6

      (-16%)

      No

      Alive

      31

      AF

      Normal

      RRT

      58

      (+15%)

      7.2

      (+101%)

      No

      Alive

      32

      IHD, CHOLES, HPT

      Normal

      RRT

      624

      (+10%)

      4.9

      (+39%)

      No

      Alive

      33

      IHD, HPT

      Normal

      CRT

      91

      (+220%)

      7.6

      (+12%)

      No

      Alive

      34

      Normal

      CRT

      509

      (-45%)

      4.7

      (-37%)

      Yes (N+V, chest pain)

      Dead

      Table 1. Listing of comorbidities, treatment, hospital admissions, ECG results and baseline biomarkers. Abbreviations: RRT (radical radiotherapy), CRT (concurrent chemo-radiation), COPD (exacerbation of COPD), NSTEMI (non-elevated ST segment myocardial infraction), N+V (nausea and vomiting), IHD (ischaemic heart disease), DM (diabetes mellitus), HPT (hypertension), CHOLES (hypercholesterolemia), AF (atrial fibrillation), RA (rheumatoid arthritis), HEPB (Hepatitis B), NTproBNP(N-terminal pro-B-type natriuretic peptide), hsTnT (high sensitivity Troponin-T)

      8eea62084ca7e541d918e823422bd82e Conclusion

      Cardiac biomarkers and their changes indicate that further investigation may be required in some to exclude cardiac ischaemia and heart failure risks before or following treatment.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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