title: Cardiac Dose and Survival After Stereotactic Body Radiotherapy for Early-stage Non-Small-cell Lung Cancer.
abstract: Recent analyses have identified cardiac dose as an important predictor of overall survival (OS) after chemoradiation for locally advanced non-small-cell lung cancer (NSCLC). However, the survival influence of the cardiac dose after stereotactic body radiotherapy (SBRT) is unknown. We performed a dose-volume histogram (DVH) analysis of patients treated with SBRT for early stage NSCLC to examine survival and cardiac toxicity.
  
  
  
  We reviewed the medical records of patients who had undergone SBRT for early-stage NSCLC from June 2007 to June 2015 and documented the cardiac DVH parameters, including the maximum and mean dose and percentage of volume receiving >5, >10, >20, and >30 Gy (V5, V10, V20, and V30, respectively). The biologically effective doses and 2-Gy equivalent doses were also calculated. The DVH parameters were assessed as predictors of OS using Cox regression analysis.
  
  
  
  We identified 102 patients with 118 treated tumors. At a median follow-up period of 27.2 months (range, 9.8-72.5 months), the 2-year OS estimate was 70.4%. The cardiac DVH parameters were as follows: maximum dose, median, 14.2 Gy (range, 0.3-77.8 Gy); mean dose, median, 1.6 Gy (range, 0-12.6 Gy); and V5, median, 8.7% (range, 0%-96.4%). We identified no correlation between OS and any cardiac dose parameter. No patient developed acute (within 3 months) cardiac toxicity. Four patients died of cardiac causes; all had had preexisting heart disease.
  
  
  
  In our cohort, cardiac dose was not a predictor of OS after lung SBRT, despite a subset of patients receiving high maximum cardiac doses. The findings from our limited cohort showed that high doses to small volumes of the heart appear safe. Analyses of larger patient cohorts with longer follow-up durations are needed to better delineate the safe cardiac DVH constraints for SBRT.
authors.affiliation: Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Amode R
authors.initials: AR
authors.lastname: Tembhekar
authors.affiliation: Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Cari L
authors.initials: CL
authors.lastname: Wright
authors.affiliation: Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CA. Electronic address: medaly@ucdavis.edu.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Daly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology / Q000528:radiation effects*; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016634:Radiosurgery / Q000009:adverse effects; D011879:Radiotherapy Dosage; D016019:Survival Analysis
keywords: Dose; Heart; NSCLC; Radiation; SBRT; Toxicity