서울의대 / 장범섭, 차명진, 장지현*
Introduction: We evaluated the incidence of cardiac events after chemoradiotherapy in patients with stage III non-small cell lung cancer (NSCLC) based on baseline cardiovascular risk and the heart substructures' radiation dose.
Methods: From 2008 to 2018, the cardiac events of 258 patients with stage III NSCLC who received definitive chemoradiotherapy were reviewed. The 10-year cardiovascular risk was calculated using the Atherosclerotic Cardiovascular Disease (ASCVD) scoring system. Dose-volume histograms were estimated for each cardiac chamber. A multivariate competing-risk regression analysis was conducted to assess each cardiac event's subhazard function (SHR).
Results: The median follow-up was 27.5 months overall and 38.9 months for survivors. Among the 179 deaths, none was definitely related to cardiac conditions. Altogether, 32 cardiovascular events affected 27 patients (10.5%) after chemoradiotherapy. Ten were major cardiac adverse events, including heart failure (N = 6) and acute coronary syndrome (ACS, N = 4). Most cardiovascular events were related to well-known risk factors. However, the volume percentage of the left ventricle (LV) receiving 60 Gy (LV V60) > 0 was significantly associated with ACS (SHR = 9.49, 95% CI = 1.28-70.53, P = 0.028). In patients with high cardiovascular risk (ASCVD score > 7.5%), LV V60 > 0% remained a negative ACS prognostic factor (P = 0.003). Meanwhile, in patients with low cardiovascular risk, the LV radiation dose was not associated with ACS events (P = 0.242).
Conclusions: A high LV radiation dose could increase ACS events in patients with stage III NSCLC and high cardiovascular risk. Pre-treatment cardiac risk evaluation and individualized surveillance may help prevent cardiac events after chemoradiotherapy.
급성 관상동맥질환에 대하여 multivariate competing-risk regression analysis를 수행하였을 때, 낮은 ASCVD risk 의 환자에서는 LV V60 이 영향이 없었던 반면, 높은 ASCVD risk 에서는 (붉은선) 관련성이 높아짐을 보여주는 그래프입니다.
3기 비소세포폐암으로 진단받고 항암방사선치료를 받은지 6년이 경과되었을 때, 흉통으로 응급실에 내원한 환자의 관상동맥 조영술결과입니다 (C). 해당 검사에서 proximal left circumflex artery의 chronic total occlusion가 관찰되었으며, 해당 부위는 B에서 60 Gy 이상을 받은 부위와 일치하였습니다.
Bum-Sup Jang 1 , Myung-Jin Cha 2 , Hak Jae Kim 3 , Seil Oh 2 , Hong-Gyun Wu 3 , Eunji Kim 4 , Byoung Hyuck Kim 5 , Jae Sik Kim 6 , Ji Hyun Chang 7
1 Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
2 Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Republic of Korea.
3 Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea.
4 Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
5 Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
6 Department of Radiation Oncology, Seoul National University Hospital, Republic of Korea.
7 Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Republic of Korea. Electronic address: firstname.lastname@example.org.