Cardiac toxicity in association with chemotherapy and radiation therapy in a large cohort of older patients with non-small-cell lung cancer.
BACKGROUND
The study's objective was to investigate the risks of developing cardiac disorders following the administration of chemotherapy and radiation therapy in patients with non-small-cell lung cancer (NSCLC).


METHODS
The study consisted of 34 209 patients aged > or =65 years with American Joint Committee on Cancer stages I-IV NSCLC identified from the Surveillance, Epidemiology, and End Result-Medicare linked database (1991-2002) who were free of cardiac disorders at NSCLC diagnosis.


RESULTS
There were significant associations between the use of chemotherapy/radiation and the risks of developing ischemic heart disease, conduction disorders, cardiac dysfunction, and heart failure. The absolute risks for cardiac dysfunction increased with the administration of chemotherapy-only and radiation-only, and incrementally with chemoradiation. Men, blacks, older patients, those with higher comorbidity scores, and advanced disease were at higher risk. The risk for ischemic heart disease increased when radiation/chemoradiation were rendered to the left lung and both lungs and for cardiac dysfunction, radiation administered to the left lung.


CONCLUSIONS
There were significant associations especially for cardiac dysfunction with use of chemotherapy/radiation therapy and risks of developing cardiac toxicity in NSCLC patients. The risks of treatment-associated cardiac toxicity, specifically ischemic heart disease and cardiac dysfunction, were greatest among those with left-sided lung tumors.
Hardy
D
D
Department of Epidemiology, Division of Epidemiology and Disease Control, University of Texas School of Public Health. Electronic address: dale.s.hardy@uth.tmc.edu.
Liu
C-C
CC
Department of Epidemiology, Division of Epidemiology and Disease Control, University of Texas School of Public Health.
Cormier
J N
JN
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center.
Xia
R
R
Department of Epidemiology, Division of Epidemiology and Disease Control, University of Texas School of Public Health.
Du
X L
XL
Department of Epidemiology, Division of Epidemiology and Disease Control, University of Texas School of Public Health; Department of Epidemiology, Center for Health Services Research, University of Texas School of Public Health, Houston, TX, USA.
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006331:Heart Diseases / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D018426:SEER Program; D015996:Survival Rate; D016896:Treatment Outcome