S. Jolly1, H. Yin2, W. Wang3, M. M. Matuszak1, P. A. Paximadis4, M. M. Dominello5, D. P. Bergsma1, S. G. Allen1, A. F. Dragovic1, L. L. Kestin6, R. T. Dess1, M. Zaki7, J. A. Hayman3, and M. Schipper2; 1Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 2Department of Biostatistics, University of Michigan, Ann Arbor, MI, 3University of Michigan, Ann Arbor, MI, 4Department of Radiation Oncology, Corewell Health South, St. Joseph, MI, 5Department of Radiation Oncology, Karmanos Cancer Center, Detroit, MI, 6Michigan Healthcare Professionals/GenesisCare USA, Farmington Hills, MI, 7Covenant HealthCare, Saginaw, MI
Purpose/Objective(s): Managing locally advanced non-small cell lung cancer (LA-NSCLC) includes chemoradiation and immunotherapy, presenting risks for delayed cardiac and pulmonary complications. This study hypothesizes that certain patient and treatment-related characteristics are predictors for these adverse events. We aim to quantify the incidence of post-treatment cardiac and pulmonary hospitalizations in LA-NSCLC patients and identify predictors to personalize treatment. Materials/
Methods: A prospectively gathered database of LA-NSCLC patients undergoing radiation in a statewide multicenter quality consortium was analyzed. From 2018 to 2023, hospitalization data due to lung and heart complications were compiled annually. Death and hospice entry were treated as competing risks when estimating cumulative incidence. Utilizing univariate and multivariate models, we explored potential associations with several patient demographic and treatment factors, including planning target volume (PTV), oxygen dependency, Eastern Cooperative Oncology Group (ECOG) performance status, Chronic Obstructive Pulmonary Disease (COPD), and radiation treatment dosimetry. Results: Follow-up time ranged from 1 to 5 years post RT, with 1 year of follow-up in 66% (405/613) and 2 or more years of follow-up in 34% (208). In total, 128 patients were hospitalized for lung-related complications including COPD exacerbation (n=44), pneumonia (n=64), and pneumonitis (n=17). Cardiac events led to hospitalization in 40 patients including arrhythmias (n=20), congestive heart failure (CHF) (n=8), pericardial effusion (n=3), and myocardial infarctions (n=8) The cumulative incidence of any lung-related hospitalization was 0.16 at one year and 0.28 at 3 years. The 1- and 3-year cumulative incidence of any cardiac-related hospitalization was 0.04 and 0.09 respectively. Notable predictors (p<0.05) of any lung and any cardiac related hospitalizations included ECOG status and baseline oxygen dependency. Mean lung dose and ECOG were identified as jointly significant predictors of pneumonitis-related admissions. Those treated with immunotherapy showed a reduced rate of cardiac admissions, likely due to healthier patients being selected for such therapies. Additionally, mean heart dose, was a significant predictor of any lung hospitalization, signifying a nuanced interaction of cardiopulmonary complications. Conclusion: This "real world" analysis of a large prospectively gathered data from a statewide consortium has revealed significant associations between mean heart dose and ECOG performance status with the incidence of cardiac and pulmonary hospitalizations following LA-NSCLC treatment. Understanding these relationships further is necessary for the implementation of risk-tailored, patient-specific treatment modalities, aiming to improve long term quality of life of LA-NSCLC patients.
