Cardiac comorbidity is an independent risk factor for radiation-induced lung toxicity in lung cancer patients
Georgi Nalbantov, Bas Kietselaer, Katrien Vandecasteele, Cary Oberije, Maaike Berbee, Esther Troost, Anne-Marie Dingemans, Angela van Baardwijk, Kim Smits, André Dekker, Johan Bussink, Dirk De Ruysscher, Yolande Lievens, Philippe Lambin, Georgi Nalbantov, Bas Kietselaer, Katrien Vandecasteele, Cary Oberije, Maaike Berbee, Esther Troost, Anne-Marie Dingemans, Angela van Baardwijk, Kim Smits, André Dekker, Johan Bussink, Dirk De Ruysscher, Yolande Lievens, Philippe Lambin
Abstract
Purpose: To test the hypothesis that cardiac comorbidity before the start of radiotherapy (RT) is associated with an increased risk of radiation-induced lung toxicity (RILT) in lung cancer patients.
Material and methods: A retrospective analysis was performed of a prospective cohort of 259 patients with locoregional lung cancer treated with definitive radio(chemo)therapy between 2007 and 2011 (ClinicalTrials.gov Identifiers: NCT00572325 and NCT00573040). We defined RILT as dyspnea CTCv.3.0 grade ≥2 within 6 months after RT, and cardiac comorbidity as a recorded treatment of a cardiac pathology at a cardiology department. Univariate and multivariate analyses, as well as external validation, were performed. The model-performance measure was the area under the receiver operating characteristic curve (AUC).
Results: Prior to RT, 75/259 (28.9%) patients had cardiac comorbidity, 44% of whom (33/75) developed RILT. The odds ratio of developing RILT for patients with cardiac comorbidity was 2.58 (p<0.01). The cross-validated AUC of a model with cardiac comorbidity, tumor location, forced expiratory volume in 1s, sequential chemotherapy and pretreatment dyspnea score was 0.72 (p<0.001) on the training set, and 0.67 (p<0.001) on the validation set.
Conclusion: Cardiac comorbidity is an important risk factor for developing RILT after definite radio(chemo)therapy of lung cancer patients.
Keywords: Cardiac comorbidity; Dyspnea; Lung cancer; Radiation-induced lung toxicity; Radiotherapy.
Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Source: PubMed