Purpose/Objective(s): To evaluate the impact of prior cardiovascular disease (CVD), cardiovascular risk factors (CVRF), dosimetric parameters and coronary artery calcium (CAC) as predictive parameters for the risk of cardiac events after radical treatment in patients with locally advanced lung cancer. Materials/
Methods: Patients with locally advanced lung cancer treated with chemo-radiotherapy (Ch-RT) in our institution between 2015-2022 were selected. We extracted clinical data and cardiac events from medical records and dosimetry parameters from the treatment planning system. A script was created within the treatment planning system, to detect CAC in the structure contoured as heart. We performed statistical analysis with statistical software (Kaplan-Meier and Cox regression analysis). Results: Our study enrolled 197 patients, 71.6% male, with a median age of 68 years (range: 46-89). 72.6% patients presented CVRF and 31.9% had prior CVD. Treatment modalities were 62.44% concurrent Ch-RT, 27.92% sequential Ch-RT, and 9.64% RT alone. Furthermore, 14.2% had surgery, and 18.3% immunotherapy. Radiotherapy techniques included 3DCRT or IMRT. The prescribed dose to the PTV was =60Gy for 83.8% of patients, and 87.4% received platinum-based doublet chemotherapy for <3 cycles. The median follow-up was 2.8 years (range: 2.5 months-8.5 years). Actuarial 2- and 5-year overall survival (OS) were 53.4% and 31.1%, respectively. Patients with stages IIIa-b presented better median OS than those with stage IIIc (37% vs. 14.9%; p=0.1). Improved OS was observed in patients who received dose =60Gy (p<0.001), followed by surgery (p<0.001) and immunotherapy (p=0.06). There were no significant differences in OS among patients treated with concomitant Ch-RT, sequential Ch-RT, or RT alone (p=0.07). Notably, prior CVD, the presence of dyslipidaemia, and CAC>3 as potential predictors of worse OS (CVD: 20.1% vs. 37.6%, p=0.03; DLP: 42.3% vs. 23.3%, p=0.01; CAC > 3: 13.5% vs. 35.6%, p=0.01). The prevalence of cardiac events was 5.58% at 3.21 years after diagnosis with a mean heart dose of 10.04 Gy (range: 0.06-34.5). Median dosimetric parameters analyzed included V5, V30, V40, and V50 (41.73%, 10.74%, 6.58%, and 3.57%, respectively). However, no statistically significant differences were found in OS or cardiac events. We analyzed patients with CAC>0 in planning CT (n=153). 72.2% of cases who presented cardiac events had a CAC>0. The presence of cardiac events showed a significant association with presence CAC (p=0.05). However, no significant associations were observed with prior CVD, the presence of CVRF, or dosimetric parameters. Conclusion: History of prior cardiopathy and dyslipidaemia are related to worse OS in patients with locally advanced lung cancer. The CAC might be valuable to identify patients with higher risk of cardiotoxicity.
