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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Wednesday, May 8, 2024
Through mechanisms that remain unknown, heart and lung radiation doses from thoracic radiotherapy have been linked with reduced survival. Arno C. Hessels, MD, PhD, of University Medical Centre Groningen, the Netherlands, and colleagues performed the ongoing CLARIFY study to determine whether early changes in cardiac morphology and function are visible after lung or esophageal cancer radiotherapy and whether the dose of radiation contributes to such changes. Their data, which suggest cardiac changes may be minimized through treatment individualization, were presented during the European Society for Radiotherapy and Oncology (ESTRO) 2024 Annual Congress (Abstract 32).
A total of 129 patients who were treated for lung (n = 49) and esophageal (n = 80) cancers between September 2018 and February 2023 were included in the analysis. Cardiac ultrasound measurements performed at baseline as well as at 6 and 52 weeks after radiotherapy were evaluated; 66 patients had 1-year follow-up data available. The analysis identified ultrasound parameters that represented changes in cardiac morphology and function.
At 6 weeks, there was a significant decrease in left ventricle outflow speed independently predicted by the lung volume receiving at least 5 Gy (P = .01). The decrease was most notable in patients who did not have induction chemotherapy (P = .01), cardiovascular comorbidity (P < .01), or chronic obstructive pulmonary disease (P < .01). Of note, there appeared to be an independent association between an increase in left ventricular mass and size with mean heart radiation dose (P < .01).
At 52 weeks, patients with cardiovascular comorbidity experienced an increase in left ventricle outflow speed that was associated with mean lung radiation dose (P < .01). Further, an increase in left ventricular mass and size was independently predicted by mean lung dose, mean heart dose, and lung volume receiving at least 5 Gy. An increase in left ventricle mass was significantly predicted by mean lung dose and lung volume receiving at least 5 Gy among patients who did not undergo induction chemotherapy (P < .01).
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