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Mohammed A Al-Sadawi



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    FP04 - Locoregional and Oligometastatic Disease (ID 126)

    • Event: WCLC 2020
    • Type: Posters (Featured)
    • Track: Locoregional and Oligometastatic Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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      FP04.01 - Heart Dose is a Dosimetric Predictor of Overall Survival in Patients with NSCLC Undergoing Post-Operative Radiation Therapy (ID 1369)

      00:00 - 00:00  |  Author(s): Mohammed A Al-Sadawi

      • Abstract
      • Presentation
      • Slides

      Introduction

      Patients undergoing PORT for locally-advanced NSCLC may be at risk for increased cardiac toxicity. There is an association between radiation dose to the heart and OS in NSCLC patients undergoing definitive radiation therapy (RT). The purpose of this analysis was to evaluate heart dose as a predictor of OS in patients with NSCLC undergoing PORT.

      Methods

      We reviewed 284 patients with NSCLC treated with PORT at our institution from 5/2004 to 1/2017. Complete dosimetric data and clinical records were reviewed, and OS was assessed. Patients were a median of 67 years old (range 28-87), and most had pathologic stage III NSCLC (91%) and received trimodality therapy (90%). Forty-six (16.2%) patients had pre-existing cardiac disease. Patients underwent lobectomy (81%), sublobar resection (12%) or pneumonectomy (7%). The rates of R0, R1 and R2 resections were 81%, 19%, and 0%, respectively. The median RT dose was 54 Gy (range: 45-70 Gy). Patients were treated with IMRT (71%) or 3DCRT (29%). Major adverse cardiac events (MACE, defined as myocardial infarction, coronary revascularization, cerebrovascular accident or heart failure) and all cardiac toxicities (including arrythmia, valvular or pericardial events) were identified. A systematic univariate Cox proportional hazards model analysis of OS and heart dose variables was performed, using the minimum dose to the hottest x% (Dx) and the volume receiving at least xGy (Vx) with x in increments of 5% and 2Gy respectively, together with mean, min, and max doses. Clinical variables that were univariately significant (p < 0.05), together with the most significant dosimetric variable, were entered in a step-up multivariate analysis.

      Results

      The median, 2-year and 5-year OS were 41.5 months, 68% and 37%, respectively. Dosimetric variables across a large range of doses to the heart were highly significant for OS, including mean (MHD), minimum and maximum heart doses. The median MHD for the population was 11.2Gy. The median OS for patients with MHD above vs. below 11.2Gy was 31.7 vs. 57.5 months (p<0.001), respectively. The volume of the heart receiving 8Gy (HV8) was the most significant dosimetric variable (p <0.0001), and the median HV8 was 35.5%. The median OS was 33.2 vs. 53.6 months (p<0.005), for patients with HV8 above or below 35.5%. On multivariable analysis, HV8 (HR:1.015/%, p<0.001), increasing age (HR:1.036/yr, p<0.001), use of anticoagulant therapy (HR:2.24, p=0.007), more extensive surgery (HR:1.49, p=0.012), and pre-operative chemotherapy (HR:1.53, p=0.019) were significant for OS. The rates of MACE and all cardiac toxicities were 7.4% and 14.8%, respectively. No heart dosimetric variables predicted for MACE or all cardiac toxicity.

      Conclusion

      Heart dose, as well as age, use of anticoagulants, presurgical chemotherapy, and the extent of surgery are predictive of worse OS in patients with NSCLC undergoing PORT. Heart V8 is the most significant dosimetric factor associated with OS. Despite the strong correlation between heart dose and OS, heart dose did not predict for cardiac events. This may indicate that the association between OS and heart dose cannot be explained fully by radiation-induced cardiac toxicities in NSCLC patients undergoing PORT.

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