Table 5.
Studies published since 2008 reporting an association between survival outcomes and heart dose.
| Study | N | Follow-up | Type of Cancer | RT Technique (s) | RT Prescription | Major Finding (s) |
|---|---|---|---|---|---|---|
| Odense Univ.r Schytte, 2010 |
250 | 7.9 yrs^ | NSCLC | 3D-CRT | 60 - 80 Gy | LV mean ≥ 14.5 Gy → ↓OS (p = 0.06) |
| Euro2Kr Tukenova, 2010 |
4122 | 26 yrs^ | Pediatric | 2D-RT | NR | Heart mean 1 Gy → ↑cardiac death excess RR 60% Heart mean 1-4.9 → ↑cardiac death RR 2.5 Heart mean 5-14.9 Gy → ↑cardiac death RR 12.5 Heart mean ≥15 Gy → ↑cardiac death RR 25.1 |
| RTOG 0617a Bradley, 2015 |
544 | 1.9 yrs^ | NSCLC | 3D-CRT (51.5%) IMRT (48.5%) |
60 Gy (57.5%) 74 Gy (42.5%) |
Heart V5 → ↓OS HR 1.007 per 1% Heart V30 → ↓OS |
| RTOG 0617a Eaton, 2016 |
495 | NR | NSCLC | 3D-CRT (51.7%) IMRT (48.3%) |
60 Gy (58.2%) 74 Gy (41.8%) |
Heart V50 → ↑Grade 5 AE |
| RTOG 0617a Chun, 2017 |
482 | 1.8 yrs^ | NSCLC | 3D-CRT (53%) IMRT (47%) |
60 Gy (58%) 74 Gy (42%) |
Heart V40 → ↓OS HR 1.01 per 1% |
| William Beaumontr Johnson, 2017 |
178 | 1.4 yrs^ | NSCLC | 3D-CRT (38.4%) IMRT (61.6%) |
64 Gy^ | Heart V30 → ↓OS HR 1.013 per 1% |
| Univ. of Manchesterr McWilliam, 2017 |
1101 | 3 - 36 mos | NSCLC | 3D-CRT IMRT SBRT (7.4%) |
55 Gy (non-SBRT) 60 Gy in 5 fx (SBRT) |
Heart base mean > 16.3 Gy → ↓OS HR 1.25 (non-SBRT) Heart base mean > 8.5 Gy vs < 8.5 Gy → ↓OS (non-SBRT) Heart base mean > 6.3 Gy → ↓OS HR 2.11 (SBRT) |
| Mayo Clinic PCIr Sio, 2017 |
76 | 5.5 yrs^ | Thoracic -Breast (57%) -NSCLC (17%) -Upper GI (11%) |
2D-RT 3D-CRT IMRT (1.3%) SBRT (2.6%) |
53.4 Gy* | Heart mean → ↓OS HR 2.01 per 1 Gy Heart mean → ↑non-cancer death HR 1.49 per 1 Gy Heart max → ↓OS after PCI HR 1.02 per 1 Gy Heart V40 → ↑non-cancer death HR 1.32 per 1% |
| Washington Univ.r Speirs, 2017 |
322 | 1.2 yrs^ | NSCLC | 3D-CRT (60%) IMRT (40%) |
66 Gy^ | Heart V50 → ↓OS HR 1.23 per 1% Heart V55 → ↓OS HR 1.85 per 1% (CRT only) |
| Multicenterr Stam, 2017 |
803 | 2.9 yrs^ | NSCLC | SBRT | 54 Gy in 3 fx^ | LA max → ↑non-cancer death HR 1.005 per 1 Gy SVC D90 → ↑non-cancer death HR 1.025 per 1 Gy |
| Meta-Analysisa Taylor, 2017 |
40,781 | 10 yrs^ | Breast | 2D-RT | NR | Heart mean → ↑cardiac death RR 1.04 per 1 Gy |
| IDEAL-CRTa Vivekanandan, 2017 |
78 | 35 mos^ | NSCLC | 3D-CRT (“most”) IMRT (“some”) |
67.7 Gy* | LA wall V63 > 2.2% → ↑OS HR 1.52 |
| Washington Univ.r Contreras, 2018 |
400 | 17 mos^ | NSCLC | 3D-CRT (59%) IMRT (41%) |
66 Gy^ | Heart V50 → ↓OS HR 1.02 per 1% |
| Princess Margaretr Wong, 2018 |
189 | 35.3 mos^ | NSCLC | SBRT | 48 Gy in 4 fx (47.1%) 54 - 60 Gy in 3 fx (24.3%) |
Ventricle max → ↑non-cancer death HR 1.02 per 1 Gy |
| Multicentera Xue, 2019 |
94 | 58 mos^ | NSCLC | 3D-CRT | 70 Gy^ | Pericardium V30 > 29% → ↓OS (HR 1.019 per 1%) Pericardium V55 > 21% → ↓OS (HR 1.03 per 1%) |
| Dana-Farber Atkins 2019 |
748 | 20.4 mos^ | NSCLC | 3D-CRT (78.1%) IMRT (21.9%) |
66 Gy^ | Heart mean → ↑ACM HR 1.02 per 1 Gy With pre-existing CHD, heart mean ≥ 10 Gy → ↑ACM HR 1.34 Without pre-existing CHD, no association between heart mean and ACM |
|
Present Study
r
Niska 2019 |
119 | 1.5 yrs^ | NSCLC | 3D-CRT (41.2%) IMRT (58.8%) |
62 Gy^ | Heart V55 → ↓OS HR 1.044 per 1% Heart V51 – V60 range predictive for OS |
Abbreviations: 2D-RT, 2-dimensional RT; 3D-CRT, 3-dimensional conformal RT; ACM, all-cause mortality; AE, adverse event; CHD, coronary heart disease; D(xx), minimum dose to xx% of the volume; fx, fractions; GI, gastrointestinal; Gy, Gray; HR, hazard ratio; IMRT, intensity-modulate RT; LA, left atrium; LV, left ventricle; mos, months; NR, not reported; NSCLC, non-small cell lung cancer; OS, overall survival; PCI, percutaneous coronary intervention; RR, relative risk; RT, radiotherapy; RTOG, Radiation Therapy Oncology Group; SBRT, stereotactic body RT; SVC, superior vena cava; univ., university; V(x), volume receiving at least x Gy; yrs, years.
indicates median
indicates mean
indicates prospective
indicates retrospective.