New Era in Radiation Oncology for Lung Cancer : Recognizing the Importance of Cardiac Irradiation
Menée à partir de données portant sur 112 patients atteints d'un cancer du poumon non à petites cellules de stade III traité entre 1996 et 2009 (durée médiane de survie : 8,8 ans), cette étude évalue le risque d'événements cardiaques symptomatiques après une radiothérapie thoracique
In the article that accompanies this editorial, Wang et al report on cardiac toxicity after radiation therapy for locally advanced non–small-cell lung cancer (NSCLC). This important original investigation represents the first published study to report an association between radiation heart dose and cardiac toxicities in patients with stage III NSCLC.
In their analysis, the investigators defined symptomatic cardiac events as symptomatic pericardial effusions, myocardial infarctions, unstable angina, pericarditis, significant arrhythmias (new-onset arrhythmias that required intervention), or heart failure. In a retrospective examination of 127 patients treated in six prospective radiotherapy dose-escalation trials (doses of 70 to 90 Gy; median, 74 Gy), they found on multivariable analysis that irradiation doses to the entire heart and to the left ventricle were associated with symptomatic cardiac events. The competing risk-adjusted event rate at 4 years was 4% in patients who received a mean heart irradiation dose less than 10 Gy, was 13% for patients who received heart doses of 10 to 20 Gy, and was 41% for patients who received heart doses greater than 20 Gy; approximately half of the events occurred within the first 2 years after irradiation. In total, 23% of patients developed symptomatic cardiac events. The median time to first event was 26 months, and significant arrhythmias, symptomatic pericardial effusions, and myocardial infarctions were most common. In addition, 36% of patients had new pericardial effusions at a median of 11 months after radiotherapy.
Journal of Clinical Oncology , éditorial en libre accès, 2016