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Radiation heart dosimetric parameters do not affect survival in NSCLC patients undergoing PORT

Tristan Manalac
05 Sep 2019

Radiation heart dosimetric parameters (RHDPs) appear to exert neutral effect on overall survival (OS) in nonsmall cell lung cancer patients undergoing postoperative thoracic radiotherapy (PORT), according to a recent Singapore study.

“In summary, there is insufficient evidence to conclude that RHDPs are associated with OS for patients with NSCLC treated with PORT,” said researchers. “This finding is promising despite the small sample size and relatively short follow-up. The patients in PORT cohort were likely very well-selected given that they were fit enough to undergo surgery.”

In the 43 included patients (median age, 63.6 years; 58 percent female) followed for a median of 36.6 months, 95 percent had good performance status, as assessed by the Eastern Cooperative Oncology Group. Majority were never smokers (67 percent) and did not have pre-existing chronic obstructive pulmonary disease (98 percent). [Medicine 2019;98:e17020]

A total of 27 deaths were reported, with a median survival of 23.4 months. The resulting 2-year and 5-year OS estimates were 65 percent and 34 percent, respectively.

Univariate Cox regression analysis identified age at lung cancer diagnosis as the only potential risk factor associated with OS, such that older participants were significantly more likely to die than their younger counterparts (hazard ratio [HR], 1.06, 95 percent CI, 1.01–1.10; p=0.008). Having a malignancy with a squamous cell histology was also a possible risk factor but only of marginal significance (HR, 2.69, 0.97–7.50; p=0.058).

Notably, the different RHDPs included in the study were of no particular importance in the context of survival. For instance, mean heart dose was not significantly associated with OS (HR, 0.99, 0.94–1.04; p=0.817), and neither were the dose to 30 percent of heart volume (HR, 1.00, 0.96–1.03; p=0.918) and mean lung dose (HR, 0.98, 0.88–1.09; p=0.705).

Similarly, the heart volumes that received ≥5 Gy (HR, 1.00, 0.98–1.01; p=0.551), ≥25 Gy (HR, 1.00, 0.97–1.02; p=0.780), ≥30 Gy (HR, 1.00, 0.97–1.03; p=0.855), ≥40 Gy (HR, 1.00, 0.96–1.04; p=0.975) and ≥50 Gy (HR, 1.01, 0.93–1.09; p=0.868) were all unrelated to the risk of death. The same was true for the lung volumes that received ≥5 Gy (HR, 0.99, 0.97–1.02; p=0.655) and ≥20 Gy (HR, 0.98, 0.93–1.03; p=0.393).

“[N]o prior study [has been conducted] to assess the relationship between RHDPs and OS in NSCLC patients who received PORT. Our study found that various RHDPs were not significantly associated with OS,” said the researchers, however pointing out that the present sample size was small and may not be exactly representative of the entire population.

“Studies with larger sample size and longer-term follow-up are needed to assess AMI outcome, given the possibility of late occurrence of AMI events,” they noted, adding that there is also a need for future efforts to identify the specific and relevant RHDPs that lead to cardiac toxicity and even death in patients undergoing PORT.

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Most Read Articles
18 May 2020
Immobilization or disuse of the forearm leads to impairment in the ability of a protein-rich meal to promote positive muscle amino acid balance, which is aggravated by dietary lipid oversupply, suggests a study. Disuse also lowers postprandial forearm amino acid uptake, but this is not exacerbated under high-fat conditions.
18 May 2020
Glucagon-like peptide-1 receptor agonists (GLP-1RA) are more effective than basal insulin in the management of total (TC) and low-density lipoprotein cholesterol (LDL-C), reveals a recent study.
17 May 2020
Increased coffee consumption among regular drinkers is associated with higher estimated glomerular filtration rate and confers protection against the risk of chronic kidney disease stages G3–G5 and albuminuria, as shown in a study.
Jairia Dela Cruz, 16 May 2020
Excess weight, greater abdominal fat, inflammation and low physical performance can all contribute to insulin resistance in middle-age Singaporean women, and these variables explain why the condition is more common among women of Chinese than Malay and Indian ethnicities, a study has found.