Predicting Adverse Cardiac Events After Radiotherapy for Locally Advanced Non–Small Cell Lung Cancer

Hyunsoo Joshua No, Felicia B. Guo, Natalie Jung-In Park, Noah Kastelowitz, June-Wha Rhee, Daniel Eugene Clark, Alexander Li-Che Chin, Lucas Kas Vitzthum, Kathleen Claire Horst, Everett James Moding, Billy W. Loo, Maximilian Diehn, and Michael Sargent Binkley
JACC: Cardiooncology
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This retrospective cohort study focused on understanding the risk factors for grade 3 cardiac events in patients undergoing radiotherapy for locally advanced non-small cell lung cancer. The study examined the associations between cardiac substructure doses and coronary artery calcium (CAC) scores with the occurrence of cardiac events. Of the 233 eligible patients, 22.3% experienced cardiac events within a median time of 21.5 months post-radiotherapy. Visual CAC scoring correlated significantly with automated scoring. In a multivariable model, Total Left volume receiving 15 Gy and CAC scores over 5 were independently associated with cardiac events. A model combining age, Total Left CAC score over 5, and volume receiving 15 Gy identified a high-risk group with a significantly higher incidence of cardiac events (28.9%) compared to a low-risk group (6.9%). This study highlights the significant associations between Total Left radiotherapy dose and cardiac events, establishing CAC as a predictive risk factor. Visual CAC scoring was compared to automated Agatston scoring using AVIEW CAC, an FDA-approved automated system.


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