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Walls G, O'Connor J, Harbsinson M, Duane FK, McCann C, McKavanagh P, Johnston D, Giacometti V, McAleese J, Hounsell A, Cole A, Butterworth K, McGarry C, Hanna GG, Jain S. Patient-Level and Endpoint-Specific Clinico-Dosimetric Analysis of the Cardiac Base as a Mediator of Radiation Cardiotoxicity in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e69-e70. [PMID: 37786026 DOI: 10.1016/j.ijrobp.2023.06.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer (NSCLC) radiation therapy. Radiation dose to the cardiac base is associated with poor overall survival in several clinical studies, but has not been validated in a non-dose escalated cohort, or with individual patient delineations. In this study we examined the impact of cardiac base dose on overall survival (OS) and cardiac events (CEs), and interrogated the relationships of the substructures comprising the heart base with OS and CEs. MATERIALS/METHODS Patients with stage I-III NSCLC treated with curative-intent radiation therapy between 2015 and 2020 at a regional cancer center were identified. Clinical notes were examined for baseline patient, tumor and cardiac details, and both cancer and cardiac outcomes. Three cardiologists verified CEs. Cardiac delineations were completed using a validated deep learning-based autosegmentation tool. Cox and Fine and Gray regressions were undertaken for the risk of death and CEs respectively, accounting for pre-specified evidence-based dose metrics and clinically relevant cardiac covariates. RESULTS Most patients received 55 Gy/20# (n = 461/478, 96%) without chemotherapy (58%), planned with VMAT (51%) or IMRT (20%). Pre-existing cardiovascular morbidity was common, with 78% having ≥2 risk factors, and 46% having >1 established cardiac disease. The median follow-up was 21.1 months. Dichotomized at the median, higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (21.6 months (95% CI 19.3-24.9) versus 29.4 months (95% CI 21.6-36.6), p = 0.021), and remained significant when statistically compared in published multivariate models. In a multivariate analysis for pooled acute CEs, heart base Dmax was associated with CEs (HR 1.75, 95% CI 1.01-1.06, p = 0.04), but this was not the case for individual CEs. Using Fine and Gray models to account for the competing risk of death, left main coronary maximum dose was associated with atrial fibrillation (p = 0.024), proximal right coronary artery V15 (p = 0.023) and mean dose (p = 0.032), and the right atrium mean dose (p = 0.029) were associated with heart failure. No dose-volume metrics were significantly associated with acute coronary syndrome. None of the constituent base substructures dose were significantly associated with death. CONCLUSION Dose to the heart base was associated with increased mortality and an increased pooled cardiac event rate. Accounting for endpoint-specific clinical covariates, only select constituent substructures of the heart base were associated with CEs and no substructures were independently associated with survival. Together, these findings are suggestive of possible interplay between the constituent base substructures in their mediation of radiation cardiotoxicity.
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Affiliation(s)
- G Walls
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J O'Connor
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - M Harbsinson
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - F K Duane
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - C McCann
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - P McKavanagh
- South Eastern Health & Social Care Trust, Belfast, United Kingdom
| | - D Johnston
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J McAleese
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - A Hounsell
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - A Cole
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - K Butterworth
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - C McGarry
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - G G Hanna
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - S Jain
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
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Houlihan O, Marlow E, Esteve S, Workman G, Byrne M, McGarry C, Grattan M, O'Keeffe S, Prise K, Hounsell A, Jain S. PD-0813 In vivo dosimetry: Optical fibre characterisation for use in adaptive HDR pelvic brachytherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02954-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Murphy R, Payan N, Osman S, Prise K, Hounsell A, O'Sullivan J, McGarry C, Jain S. PO-1769 Prostate cancer radiogenomics machine learning classification for predicting disease progression. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Turner P, Jain S, Mitchell D, Hounsell A, Biggart S, O'Sullivan J. First Results from the ADRRAD Trial – Combination Androgen Deprivation Therapy (ADT), Whole Pelvis Radiotherapy (WPRT) and Radium 223 in Recently Diagnosed Metastatic Hormone Sensitive Prostate Cancer (MHSPCa). Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2017.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McMahon S, McGarry C, Butterworth K, O'Sullivan J, Hounsell A, Prise K. PO-0968: Intercellular signalling in radiotherapy: Implications for margins, fractions, and modalities. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Corrie PG, Moody AM, Armstrong G, Nolasco S, Lao-Sirieix SH, Bavister L, Prevost AT, Parker R, Sabes-Figuera R, McCrone P, Balsdon H, McKinnon K, Hounsell A, O'Sullivan B, Barclay S. Is community treatment best? a randomised trial comparing delivery of cancer treatment in the hospital, home and GP surgery. Br J Cancer 2013; 109:1549-55. [PMID: 23989945 PMCID: PMC3776975 DOI: 10.1038/bjc.2013.414] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Care closer to home is being explored as a means of improving patient experience as well as efficiency in terms of cost savings. Evidence that community cancer services improve care quality and/or generate cost savings is currently limited. A randomised study was undertaken to compare delivery of cancer treatment in the hospital with two different community settings. METHODS Ninety-seven patients being offered outpatient-based cancer treatment were randomised to treatment delivered in a hospital day unit, at the patient's home or in local general practice (GP) surgeries. The primary outcome was patient-perceived benefits, using the emotional function domain of the EORTC quality of life (QOL) QLQC30 questionnaire evaluated after 12 weeks. Secondary outcomes included additional QOL measures, patient satisfaction, safety and health economics. RESULTS There was no statistically significant QOL difference between treatment in the combined community locations relative to hospital (difference of -7.2, 95% confidence interval: -19·5 to +5·2, P=0.25). There was a significant difference between the two community locations in favour of home (+15·2, 1·3 to 29·1, P=0.033). Hospital anxiety and depression scale scores were consistent with the primary outcome measure. There was no evidence that community treatment compromised patient safety and no significant difference between treatment arms in terms of overall costs or Quality Adjusted Life Year. Seventy-eight percent of patients expressed satisfaction with their treatment whatever their location, whereas 57% of patients preferred future treatment to continue at the hospital, 81% at GP surgeries and 90% at home. Although initial pre-trial interviews revealed concerns among health-care professionals and some patients regarding community treatment, opinions were largely more favourable in post-trial interviews. INTERPRETATION Patient QOL favours delivering cancer treatment in the home rather than GP surgeries. Nevertheless, both community settings were acceptable to and preferred by patients compared with hospital, were safe, with no detrimental impact on overall health-care costs.
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Affiliation(s)
- P G Corrie
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - A M Moody
- West Suffolk Hospital, Bury St Edmunds, Suffolk, UK
| | - G Armstrong
- Cambridge Clinical Trials Unit – Cancer Theme, Addenbrooke's Hospital, Cambridge, UK
| | - S Nolasco
- Cambridge Clinical Trials Unit – Cancer Theme, Addenbrooke's Hospital, Cambridge, UK
| | - S-H Lao-Sirieix
- Cambridge Clinical Trials Unit – Cancer Theme, Addenbrooke's Hospital, Cambridge, UK
| | - L Bavister
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | | | - R Parker
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | - H Balsdon
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - K McKinnon
- West Suffolk Hospital, Bury St Edmunds, Suffolk, UK
| | - A Hounsell
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - B O'Sullivan
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - S Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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O'Keeffe S, Grattan M, Hounsell A, McCarthy D, Woulfe P, Cronin J, Lewis E. Radiotherapy dosimetry based on plastic optical fibre sensors. ACTA ACUST UNITED AC 2013. [DOI: 10.1117/12.2025864] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hounsell A. SP-0401: Radiobiology implications of Flattening Filter Free treatments. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hounsell A, Hanna G, Carson K, McAleese J, Cosgrove V, Eakin R, Stewart D, Zatari A, O'Sullivan J. The Impact on PTVs and Normal Lung Dose of Using 18F-FDF PET/CT Simulation on an Already PET/CT Staged Cohort of NSCLC Patients. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hanna G, Van S¨ornsen de Koste R, Dahele M, Carson K, Haasbeek C, Migchielsen R, Hounsell A, Senan S. Defining target volumes for treatment of peripheral lung tumours with radiotherapy: A comparison of 18F-FDG-positron emission tomography and 4-dimensional CT scanning. Lung Cancer 2010. [DOI: 10.1016/s0169-5002(10)70099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hounsell A, Carsonz K, Zatari A, Cosgrove V, Eakin R, Clarke J, Stewart D, Fleming L, Jarritt P. 363 Investigations into the determination of target volumes using 18FDG-PET-CT images for radiotherapy treatment planning. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81339-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Flemino L, Hounsell A, Cosgrove V, Carson K, Zatari A, Eakin R, Stewart D, Clarke J, Jarritt P. 95 The role of PET-CT images in radiotherapy treatment planning for lung cancer. Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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