WCLC 2025 - Posters & ePosters-P2.08 .13 Radiation Dose to the Heart and Cardiac Substructures Associated With Adverse Cardiac Events in Locally-Advanced Non-Small Cell Lung Cancer

P2.08 .13 Radiation Dose to the Heart and Cardiac Substructures Associated With Adverse Cardiac Events in Locally-Advanced Non-Small Cell Lung Cancer

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This study investigates the relationship between radiation dose to cardiac substructures and the incidence of adverse cardiac events in patients with locally-advanced non-small cell lung cancer (NSCLC) treated with definitive chemoradiotherapy (chemoRT).<br /><br />Key findings from a cohort of 320 patients with a median follow-up of 46 months include an 18% 5-year actuarial incidence of general cardiac events and an 8.4% incidence of major adverse cardiac events (such as unstable angina, coronary revascularization, myocardial infarction, congestive heart failure, or cardiac death). Importantly, treatment-related factors (particularly radiation technique and adjuvant immunotherapy) were more strongly associated with post-treatment cardiac events than baseline cardiac risk factors or pre-existing cardiac disease.<br /><br />The study highlights novel associations between increasing radiation dose to the pulmonary artery and higher risks of cardiac arrhythmias including atrial fibrillation. Specifically, higher pulmonary artery V15 and V25 values (volumes receiving ≥15 Gy and ≥25 Gy, respectively) were predictive of increased arrhythmia risk. The 5-year risk of atrial fibrillation was 6.9%, while the risk of any cardiac arrhythmia was 11.7%.<br /><br />Radiation treatment methods influenced risk: patients treated with three-dimensional radiation therapy (3D RT) had a significantly higher hazard ratio (HR 3.93) for adverse cardiac events compared with other techniques such as intensity-modulated radiation therapy (IMRT). Adjuvant immunotherapy also increased risk (HR 2.73).<br /><br />The study emphasizes the importance of cardiac substructure dosimetry, suggesting specific cardiac regions—like the pulmonary artery—may be critical in predicting and managing post-treatment cardiac complications in lung cancer patients. Given the increasing use of cardio-oncology approaches, these findings warrant further investigation to optimize radiotherapy planning and reduce cardiac morbidity in this high-risk population.<br /><br />Overall, the results underline that cardiac injury after lung cancer chemoRT is influenced more by treatment factors than by patients’ baseline cardiac health, highlighting a need for strategies to minimize radiation exposure to sensitive cardiac substructures.

Asset Subtitle

Christopher Kelsey

Meta Tag

Speaker Christopher Kelsey

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

radiation dose

cardiac substructures

adverse cardiac events

non-small cell lung cancer

chemoradiotherapy

pulmonary artery

cardiac arrhythmias

atrial fibrillation

3D radiation therapy

immunotherapy