Heart dose exposure as prognostic marker after radiotherapy for resectable stage IIIA/B non-small-cell lung cancer: secondary analysis of a randomized trial
Heart exposure to ionizing irradiation can cause ischaemic heart disease. The partial heart volume receiving ≥5Gy (heartV5) was supposed to be an independent prognostic factor for survival after radiochemotherapy for locally advanced non-small-cell lung cancer (NSCLC). But validation of the latter h...
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| Veröffentlicht in: | Annals of oncology 2017-05, Vol.28 (5), p.1084-1089 |
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| creator | Guberina, M. Eberhardt, W. Stuschke, M. Gauler, T. Heinzelmann, F. Cheufou, D. Kimmich, M. Friedel, G. Schmidberger, H. Darwiche, K. Jendrossek, V. Schuler, M. Stamatis, G. Pöttgen, C. |
| description | Heart exposure to ionizing irradiation can cause ischaemic heart disease. The partial heart volume receiving ≥5Gy (heartV5) was supposed to be an independent prognostic factor for survival after radiochemotherapy for locally advanced non-small-cell lung cancer (NSCLC). But validation of the latter hypothesis is needed under the concurrent risks of lung cancer patients.
The ESPATUE phase III trial recruited patients with potentially operable IIIA(N2)/selected IIIB NSCLC between 01/2004 and 01/2013. Cisplatin/paclitaxel induction chemotherapy was given followed by neoadjuvant radiochemotherapy (RT/CT) to 45Gy (1.5Gy bid/concurrent cisplatin/vinorelbine). Operable patients were randomized to definitive RT/CT(arm A) or surgery (arm B) and therefore were treated at two different total dose levels of radiotherapy. HeartV5 and mean heart dose (MHD) were obtained from the 3D radiotherapy plans, the prognostic value was analysed using multivariable proportional hazard analysis.
A total of 161 patients were randomized in ESPATUE, heartV5 and MHD were obtained from the 3D radiotherapy plans for 155 of these [male/female:105/50, median age 58 (33–74) years, stage IIIA/IIIB: 54/101]. Power analysis revealed a power of 80% of this dataset to detect a prognostic value of heartV5 of the size found in RTOG 0617. Multivariable analysis did not identify heartV5 as an independent prognostic factor for survival adjusting for tumour and clinical characteristics with [hazard ratio 1.005 (0.995–1.015), P=0.30] or without lower lobe tumour location [hazard ratio 0.999 (0.986–1.012), P=0.83]. There was no influence of heartV5 on death without tumour progression. Tumour progression, and pneumonia were the leading causes of death representing 65% and 14% of the observed deaths.
HeartV5 could not be validated as an independent prognostic factor for survival after neoadjuvant or definitive conformal radiochemotherapy. Tumour progression was the predominant cause of death.
Z5 - 22461/2 - 2002-017 (German Federal Office for Radiation Protection). |
| doi_str_mv | 10.1093/annonc/mdx069 |
| format | Article |
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The ESPATUE phase III trial recruited patients with potentially operable IIIA(N2)/selected IIIB NSCLC between 01/2004 and 01/2013. Cisplatin/paclitaxel induction chemotherapy was given followed by neoadjuvant radiochemotherapy (RT/CT) to 45Gy (1.5Gy bid/concurrent cisplatin/vinorelbine). Operable patients were randomized to definitive RT/CT(arm A) or surgery (arm B) and therefore were treated at two different total dose levels of radiotherapy. HeartV5 and mean heart dose (MHD) were obtained from the 3D radiotherapy plans, the prognostic value was analysed using multivariable proportional hazard analysis.
A total of 161 patients were randomized in ESPATUE, heartV5 and MHD were obtained from the 3D radiotherapy plans for 155 of these [male/female:105/50, median age 58 (33–74) years, stage IIIA/IIIB: 54/101]. Power analysis revealed a power of 80% of this dataset to detect a prognostic value of heartV5 of the size found in RTOG 0617. Multivariable analysis did not identify heartV5 as an independent prognostic factor for survival adjusting for tumour and clinical characteristics with [hazard ratio 1.005 (0.995–1.015), P=0.30] or without lower lobe tumour location [hazard ratio 0.999 (0.986–1.012), P=0.83]. There was no influence of heartV5 on death without tumour progression. Tumour progression, and pneumonia were the leading causes of death representing 65% and 14% of the observed deaths.
HeartV5 could not be validated as an independent prognostic factor for survival after neoadjuvant or definitive conformal radiochemotherapy. Tumour progression was the predominant cause of death.
Z5 - 22461/2 - 2002-017 (German Federal Office for Radiation Protection).</description><identifier>ISSN: 0923-7534</identifier><identifier>EISSN: 1569-8041</identifier><identifier>DOI: 10.1093/annonc/mdx069</identifier><identifier>PMID: 28453703</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Aged ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - therapy ; Chemoradiotherapy - adverse effects ; concurrent chemotherapy ; Dose-Response Relationship, Radiation ; Female ; Heart - radiation effects ; heart dose ; Humans ; lung cancer ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; Lung Neoplasms - therapy ; Male ; Middle Aged ; Myocardium - pathology ; Neoplasm Staging ; Prognosis ; prognostic factor ; Proportional Hazards Models ; Radiation Injuries - diagnosis ; Radiation Injuries - etiology ; radiotherapy ; Treatment Outcome</subject><ispartof>Annals of oncology, 2017-05, Vol.28 (5), p.1084-1089</ispartof><rights>2017 European Society for Medical Oncology</rights><rights>The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c380t-b45b0d6f3d8542478b45663cbd897061b6a1ef1fe5b9976b666c71ec5aa0a5f03</citedby><cites>FETCH-LOGICAL-c380t-b45b0d6f3d8542478b45663cbd897061b6a1ef1fe5b9976b666c71ec5aa0a5f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28453703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guberina, M.</creatorcontrib><creatorcontrib>Eberhardt, W.</creatorcontrib><creatorcontrib>Stuschke, M.</creatorcontrib><creatorcontrib>Gauler, T.</creatorcontrib><creatorcontrib>Heinzelmann, F.</creatorcontrib><creatorcontrib>Cheufou, D.</creatorcontrib><creatorcontrib>Kimmich, M.</creatorcontrib><creatorcontrib>Friedel, G.</creatorcontrib><creatorcontrib>Schmidberger, H.</creatorcontrib><creatorcontrib>Darwiche, K.</creatorcontrib><creatorcontrib>Jendrossek, V.</creatorcontrib><creatorcontrib>Schuler, M.</creatorcontrib><creatorcontrib>Stamatis, G.</creatorcontrib><creatorcontrib>Pöttgen, C.</creatorcontrib><title>Heart dose exposure as prognostic marker after radiotherapy for resectable stage IIIA/B non-small-cell lung cancer: secondary analysis of a randomized trial</title><title>Annals of oncology</title><addtitle>Ann Oncol</addtitle><description>Heart exposure to ionizing irradiation can cause ischaemic heart disease. The partial heart volume receiving ≥5Gy (heartV5) was supposed to be an independent prognostic factor for survival after radiochemotherapy for locally advanced non-small-cell lung cancer (NSCLC). But validation of the latter hypothesis is needed under the concurrent risks of lung cancer patients.
The ESPATUE phase III trial recruited patients with potentially operable IIIA(N2)/selected IIIB NSCLC between 01/2004 and 01/2013. Cisplatin/paclitaxel induction chemotherapy was given followed by neoadjuvant radiochemotherapy (RT/CT) to 45Gy (1.5Gy bid/concurrent cisplatin/vinorelbine). Operable patients were randomized to definitive RT/CT(arm A) or surgery (arm B) and therefore were treated at two different total dose levels of radiotherapy. HeartV5 and mean heart dose (MHD) were obtained from the 3D radiotherapy plans, the prognostic value was analysed using multivariable proportional hazard analysis.
A total of 161 patients were randomized in ESPATUE, heartV5 and MHD were obtained from the 3D radiotherapy plans for 155 of these [male/female:105/50, median age 58 (33–74) years, stage IIIA/IIIB: 54/101]. Power analysis revealed a power of 80% of this dataset to detect a prognostic value of heartV5 of the size found in RTOG 0617. Multivariable analysis did not identify heartV5 as an independent prognostic factor for survival adjusting for tumour and clinical characteristics with [hazard ratio 1.005 (0.995–1.015), P=0.30] or without lower lobe tumour location [hazard ratio 0.999 (0.986–1.012), P=0.83]. There was no influence of heartV5 on death without tumour progression. Tumour progression, and pneumonia were the leading causes of death representing 65% and 14% of the observed deaths.
HeartV5 could not be validated as an independent prognostic factor for survival after neoadjuvant or definitive conformal radiochemotherapy. Tumour progression was the predominant cause of death.
Z5 - 22461/2 - 2002-017 (German Federal Office for Radiation Protection).</description><subject>Adult</subject><subject>Aged</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - therapy</subject><subject>Chemoradiotherapy - adverse effects</subject><subject>concurrent chemotherapy</subject><subject>Dose-Response Relationship, Radiation</subject><subject>Female</subject><subject>Heart - radiation effects</subject><subject>heart dose</subject><subject>Humans</subject><subject>lung cancer</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>Neoplasm Staging</subject><subject>Prognosis</subject><subject>prognostic factor</subject><subject>Proportional Hazards Models</subject><subject>Radiation Injuries - diagnosis</subject><subject>Radiation Injuries - etiology</subject><subject>radiotherapy</subject><subject>Treatment Outcome</subject><issn>0923-7534</issn><issn>1569-8041</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUFv1DAQhS0EokvhyBX5yCWsvU7shFtZAV2pEhc4WxN7shgce7Gdqtvfwo_FVQo3LjPS6JunmfcIec3ZO84GsYUQYjDb2d4xOTwhG97JoelZy5-SDRt2olGdaC_Ii5x_MFaR3fCcXOz6thOKiQ35fY2QCrUxI8W7U8xLQgqZnlI8hpiLM3SG9BMThanUmsC6WL5jgtOZTrEOMKMpMHqkucAR6eFwuNp-oPWqJs_gfWPQe-qXcKQGgsH0ntaNGCykM4UA_pxdpnGiUMWDjbO7R0tLcuBfkmcT-IyvHvsl-fbp49f9dXPz5fNhf3XTGNGz0oxtNzIrJ2H7rt21qq8DKYUZbT8oJvkogePEJ-zGYVBylFIaxdF0AAy6iYlL8nbVrV__WjAXPbv8cDYEjEvWvB9E1yqpeEWbFTUp5pxw0qfkqkNnzZl-CESvgeg1kMq_eZRexhntP_pvAhVQK4D1wVuHSWfjsPpkXarGahvdf6T_AL3vn7k</recordid><startdate>201705</startdate><enddate>201705</enddate><creator>Guberina, M.</creator><creator>Eberhardt, W.</creator><creator>Stuschke, M.</creator><creator>Gauler, T.</creator><creator>Heinzelmann, F.</creator><creator>Cheufou, D.</creator><creator>Kimmich, M.</creator><creator>Friedel, G.</creator><creator>Schmidberger, H.</creator><creator>Darwiche, K.</creator><creator>Jendrossek, V.</creator><creator>Schuler, M.</creator><creator>Stamatis, G.</creator><creator>Pöttgen, C.</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201705</creationdate><title>Heart dose exposure as prognostic marker after radiotherapy for resectable stage IIIA/B non-small-cell lung cancer: secondary analysis of a randomized trial</title><author>Guberina, M. ; 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The partial heart volume receiving ≥5Gy (heartV5) was supposed to be an independent prognostic factor for survival after radiochemotherapy for locally advanced non-small-cell lung cancer (NSCLC). But validation of the latter hypothesis is needed under the concurrent risks of lung cancer patients.
The ESPATUE phase III trial recruited patients with potentially operable IIIA(N2)/selected IIIB NSCLC between 01/2004 and 01/2013. Cisplatin/paclitaxel induction chemotherapy was given followed by neoadjuvant radiochemotherapy (RT/CT) to 45Gy (1.5Gy bid/concurrent cisplatin/vinorelbine). Operable patients were randomized to definitive RT/CT(arm A) or surgery (arm B) and therefore were treated at two different total dose levels of radiotherapy. HeartV5 and mean heart dose (MHD) were obtained from the 3D radiotherapy plans, the prognostic value was analysed using multivariable proportional hazard analysis.
A total of 161 patients were randomized in ESPATUE, heartV5 and MHD were obtained from the 3D radiotherapy plans for 155 of these [male/female:105/50, median age 58 (33–74) years, stage IIIA/IIIB: 54/101]. Power analysis revealed a power of 80% of this dataset to detect a prognostic value of heartV5 of the size found in RTOG 0617. Multivariable analysis did not identify heartV5 as an independent prognostic factor for survival adjusting for tumour and clinical characteristics with [hazard ratio 1.005 (0.995–1.015), P=0.30] or without lower lobe tumour location [hazard ratio 0.999 (0.986–1.012), P=0.83]. There was no influence of heartV5 on death without tumour progression. Tumour progression, and pneumonia were the leading causes of death representing 65% and 14% of the observed deaths.
HeartV5 could not be validated as an independent prognostic factor for survival after neoadjuvant or definitive conformal radiochemotherapy. Tumour progression was the predominant cause of death.
Z5 - 22461/2 - 2002-017 (German Federal Office for Radiation Protection).</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>28453703</pmid><doi>10.1093/annonc/mdx069</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - therapy Chemoradiotherapy - adverse effects concurrent chemotherapy Dose-Response Relationship, Radiation Female Heart - radiation effects heart dose Humans lung cancer Lung Neoplasms - mortality Lung Neoplasms - pathology Lung Neoplasms - therapy Male Middle Aged Myocardium - pathology Neoplasm Staging Prognosis prognostic factor Proportional Hazards Models Radiation Injuries - diagnosis Radiation Injuries - etiology radiotherapy Treatment Outcome |
| title | Heart dose exposure as prognostic marker after radiotherapy for resectable stage IIIA/B non-small-cell lung cancer: secondary analysis of a randomized trial |
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