Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 5:25:100410.
doi: 10.1016/j.phro.2023.01.001. eCollection 2023 Jan.

Association of cardiac calcium burden with overall survival after radiotherapy for non-small cell lung cancer

Justin M Haseltine  1 , Aditya Apte  2 , Andrew Jackson  2 , Ellen Yorke  2 , Anthony F Yu  3 , Andrew Plodkowski  4 , Abraham Wu  1 , Ariel Peleg  5 , Mohammed Al-Sadawi  6 , Michelle Iocolano  7 , Daphna Gelblum  1 , Narek Shaverdian  1 , Charles B Simone 2nd  1 , Andreas Rimner  1 , Daniel R Gomez  1 , Annemarie F Shepherd  1 , Maria Thor  2
Affiliations

Association of cardiac calcium burden with overall survival after radiotherapy for non-small cell lung cancer

Justin M Haseltine et al. Phys Imaging Radiat Oncol. .

Abstract

Background and purpose: Coronary calcifications are associated with coronary artery disease in patients undergoing radiotherapy (RT) for non-small cell lung cancer (NSCLC). We quantified calcifications in the coronary arteries and aorta and investigated their relationship with overall survival (OS) in patients treated with definitive RT (Def-RT) or post-operative RT (PORT).

Materials and methods: We analyzed 263 NSCLC patients treated from 2004 to 2017. Calcium burden was ascertained with a Hounsfield unit (HU) cutoff of > 130 in addition to a deep learning (DL) plaque estimator. The HU cutoff volumes were defined for coronary arteries (PlaqueCoro) and coronary arteries and aorta combined (PlaqueCoro+Ao), while the DL estimator ranged from 0 (no plaque) to 3 (high plaque). Patient and treatment characteristics were explored for association with OS.

Results: The median PlaqueCoro and PlaqueCoro+Ao was 0.75 cm3 and 0.87 cm3 in the Def-RT group and 0.03 cm3 and 0.52 cm3 in the PORT group. The median DL estimator was 2 in both cohorts. In Def-RT, large PlaqueCoro (HR:1.11 (95%CI:1.04-1.19); p = 0.008), and PlaqueCoro+Ao (HR:1.06 (95%CI:1.02-1.11); p = 0.03), and poor Karnofsky Performance Status (HR: 0.97 (95%CI: 0.94-0.99); p = 0.03) were associated with worse OS. No relationship was identified between the plaque volumes and OS in PORT, or between the DL plaque estimator and OS in either Def-RT or PORT.

Conclusions: Coronary artery calcification assessed from RT planning CT scans was significantly associated with OS in patients who underwent Def-RT for NSCLC. This HU thresholding method can be straightforwardly implemented such that the role of calcifications can be further explored.

Keywords: Coronary calcifications; Non-small cell lung cancer; Radiotherapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A patient with a total plaque volume (PlaqueCoro+Ao) around the cohort median in Def-RT (0.87 cm3; 1A), and around the cohort median PlaqueCoro+Ao in PORT (0.52 cm3; 1B). Scatter plot between PlaqueCoro and PlaqueCoro+Ao separated for OS status in the Def-RT (1C) and in PORT (1D).
Fig. 2
Fig. 2
A-C. Def-RT cohort. Kaplan-Meier curves stratified with respect to the median value of PlaqueCoro (2A), and with respect to the median value of the prognostic index (PI=(0.11* PlaqueCoro)+(-0.03*KPS)) combining PlaqueCoro and KPS (2B; p-values from a log-rank test). 2C: Boxplots with individual patients as scatter representations of PlaqueCoro stratified between KPS 60 and 70 combined, KPS 80 and KPS 90 and color-coded with respect to survival status. Note: The y-axis inFig. 2C has been truncated for improved visualization excluding two data points (PlaqueCoro = 21.05 cm3 and KPS = 80; PlaqueCoro = 19.81 cm3 and KPS = 90).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bradley J.D., Paulus R., Komaki R., Masters G., Blumenschein G., Schild S., et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol. 2015;16:187–199. doi: 10.1016/S1470-2045(14)71207-0. - DOI - PMC - PubMed
    1. Speirs C.K., DeWees T.A., Rehman S., Molotievschi A., Velez M.A., Mullen D., et al. Heart dose is an independent dosimetric predictor of overall survival in locally advanced non-small cell lung cancer. J Thorac Oncol. 2017;12:293–301. doi: 10.1016/j.jtho.2016.09.134. - DOI - PubMed
    1. Bradley J.D., Hu C., Komaki R.R., Masters G.A., Blumenschein G.R., Schild S.E., et al. Long-term results of NRG Oncology RTOG 0617: standard- versus high-dose chemoradiotherapy with or without cetuximab for unresectable stage III non-small-cell lung cancer. J Clin Oncol. 2020;38:706–714. doi: 10.1200/JCO.19.01162. - DOI - PMC - PubMed
    1. Thor M., Deasy J.O., Hu C., Gore E., Bar-Ad V., Robinson C., et al. Modeling the impact of cardiopulmonary irradiation on overall survival in NRG oncology trial RTOG 0617. Clin Cancer Res. 2020;26:4643–4650. doi: 10.1158/1078-0432.CCR-19-2627. - DOI - PMC - PubMed
    1. Wang K., Eblan M.J., Deal A.M., Lipner M., Zagar T.M., Wang Y., et al. Cardiac toxicity after radiotherapy for stage III non-small-cell lung cancer: pooled analysis of dose-escalation trials delivering 70 to 90 Gy. J Clin Oncol. 2017;35:1387–1394. doi: 10.1200/JCO.2016.70.0229. - DOI - PMC - PubMed

LinkOut - more resources