Higher Lung and Heart Doses Decrease Early and Long-Term Survival, Respectively, in Patients With Non-Small Cell Lung...

Area of Science:

• Radiation Oncology
• Medical Physics
• Oncology

Background:

• Cardiopulmonary toxicity from postoperative radiation therapy (PORT) can impact non-small cell lung cancer (NSCLC) treatment efficacy.
• Limited research exists on the specific correlation between heart and lung radiation doses and overall survival (OS) in NSCLC patients post-PORT.

Purpose of the Study:

• To investigate the relationship between radiation doses delivered to the heart and lungs and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) undergoing postoperative radiation therapy (PORT).

Main Methods:

• Retrospective analysis of 307 NSCLC patients receiving 50 Gy PORT.
• Landmark analyses at 36 months to assess early (≤36 months) and long-term (>36 months) survival.
• Stabilized inverse probability of treatment weighting (sIPTW) to balance patient characteristics between high- and low-dose groups.
• Sensitivity analyses conducted at 24 and 48 months.

Main Results:

• Higher heart doses significantly correlated with decreased long-term survival (HR, 1.14; P=.015) but not early or overall survival.
• Lung doses showed a marginal correlation with decreased early survival (HR, 1.03; P=.07) but not long-term or overall survival.
• These associations persisted after sIPTW, with higher heart and lung doses linked to reduced long-term and early survival, respectively.

Conclusions:

• In NSCLC patients undergoing PORT, elevated heart radiation doses are associated with diminished long-term survival.
• Increased lung radiation doses are linked to reduced early survival in this patient cohort.
• These findings underscore the importance of dose optimization to mitigate cardiopulmonary toxicity and improve survival outcomes in NSCLC patients receiving PORT.