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Does Dose to the Heart Influence Overall Survival in Stage III Non Small Cell Lung Cancer Patients Undergoing Radiation Therapy?

X Liu1*, S Schild2 , M Herman3 , J Li1 , M Fatyga2 , (1) Arizona State University, Tempe, AZ, (2) Mayo Clinic, Phoenix, Arizona, (3) Mayo Clinic, Rochester, MN,


(Tuesday, 7/31/2018) 3:45 PM - 4:15 PM

Room: Exhibit Hall | Forum 9

Purpose: To determine if radiation induced cardiac toxicity influences overall survival (OS) in stage III lung cancer patients.

Methods: A database of 137, stage III, non-small cell lung cancer patients treated with Radiation Therapy at Mayo Clinic Arizona was used in this study. The heart structure was contoured for each patient within the Varian Eclipse Treatment Planning System (TPS). We used whole heart cumulative dose volume histogram (DVH) to model OS using both univariate logistic regression and multivariate logistic regression with stepwise argument selection through Akaike Information Criterion (AIC). We digitally subdivided each heart structure into four compartments and used dose distribution in each compartment to search for parts of the heart which may be most sensitive to radiation induced toxicity.

Results: 60% of patients presented with stage IIIA and 40% with stage IIIB cancer. Dose prescribed was 61.9±6.8Gy and 77% of patients also received chemotherapy. Mean dose to the heart was 10±9Gy. On univariate analysis no single whole heart DVH index was found to be predictive for OS. On multivariate analysis OS was shown to be influenced by cancer stage (p=0.02), chemotherapy (p=0.0003), patient age (p=0.03) and whole heart DVH indices D50% - D60% (p= 0.01 – 0.05), D30% and Mean Dose (p=0.05). A digital subdivision of the heart into four segments suggests that the dose delivered to the right side of the heart had the greatest influence on the OS in this patient population (p=0.03 – 0.05).

Conclusion: Dose deposition in the heart may be one of the factors which influence overall survival in lung cancer patients undergoing radiation therapy for stage III lung cancer.


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