Clinical and translational radiation oncology · 2025
Cardiac substructure radiotherapy dose and changes in physical activity and quality of life after chemoradiotherapy for NSCLC: a secondary analysis of the CLARITY prospective study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Yegya-Raman Nikhil, Ko Kyunga, Han Ivy S, Mitchell Joshua D, Zou Wei, Ohri Nitin, Jabbour Salma K, Mak Raymond H, Robinson Clifford, Levin William P, Barrett Leanne, Xia Congying, Berlin Eva, Bravo Paco, Carli Marcelo Di, Cohen Roger, Hutton Sandra, Keltz Jonathan, Wang Jessica, Fasan Omotayo, Nagda Suneel N, Seo Angie, Smith Amanda M, Sun Lova, Soike Michael, Kole Adam J, Walls Gerard, Feigenberg Steven J, Ky Bonnie
Аннотация
PURPOSE: The objective was to assess associations between cardiac substructure dose and changes in patient-reported outcomes (PROs) post-chemoradiotherapy for non-small cell lung cancer (NSCLC).
METHODS AND MATERIALS: The study population was derived from CLARITY (NCT04305613), a multi-institutional longitudinal prospective cohort study. Patients treated with conventionally fractionated radiotherapy (1.8-2 Gy per fraction) with concurrent chemotherapy completed physical activity (Godin) and quality of life (FACIT-Fatigue and Dyspnea) questionnaires at baseline, completion of radiotherapy, 6 and 12 months post-radiotherapy. Thirty cardiac dosimetric parameters were a priori selected from centrally contoured radiotherapy plans: mean dose, maximum dose, volume receiving ≥ 5 Gy (V5Gy), V15Gy, and V30Gy to the whole heart, left ventricle, right ventricle, left atrium, right atrium, and left anterior descending coronary artery, and applied to a LASSO regression model to further define variable importance. Associations between cardiac radiation dose metrics and changes in PROs were assessed using repeated-measures linear regression via generalized estimating equations with correction for multiple testing.
RESULTS: In a subcohort of 122 patients, the median age was 67 years, 57% were male, and 41% had prevalent cardiovascular disease. Median whole heart mean dose was 9 Gy, whole heart maximum dose was 64 Gy, and LAD V15Gy was 1%. Godin physical activity (p = 0.0499), FACIT-Fatigue (p < 0.001), and FACIT-Dyspnea scores (p = 0.0037) worsened from baseline to end of radiotherapy, then recovered to baseline levels thereafter. In multivariable analysis and after adjusting for multiple comparisons, no cardiac dose metric was significantly associated with a worsening in patient-reported physical activity, fatigue or dyspnea (p > 0.05).
CONCLUSIONS: PROs worsened from baseline to the end of thoracic chemoradiotherapy, then recovered to baseline levels. Cardiac radiation dose metrics were not associated with these changes.
METHODS AND MATERIALS: The study population was derived from CLARITY (NCT04305613), a multi-institutional longitudinal prospective cohort study. Patients treated with conventionally fractionated radiotherapy (1.8-2 Gy per fraction) with concurrent chemotherapy completed physical activity (Godin) and quality of life (FACIT-Fatigue and Dyspnea) questionnaires at baseline, completion of radiotherapy, 6 and 12 months post-radiotherapy. Thirty cardiac dosimetric parameters were a priori selected from centrally contoured radiotherapy plans: mean dose, maximum dose, volume receiving ≥ 5 Gy (V5Gy), V15Gy, and V30Gy to the whole heart, left ventricle, right ventricle, left atrium, right atrium, and left anterior descending coronary artery, and applied to a LASSO regression model to further define variable importance. Associations between cardiac radiation dose metrics and changes in PROs were assessed using repeated-measures linear regression via generalized estimating equations with correction for multiple testing.
RESULTS: In a subcohort of 122 patients, the median age was 67 years, 57% were male, and 41% had prevalent cardiovascular disease. Median whole heart mean dose was 9 Gy, whole heart maximum dose was 64 Gy, and LAD V15Gy was 1%. Godin physical activity (p = 0.0499), FACIT-Fatigue (p < 0.001), and FACIT-Dyspnea scores (p = 0.0037) worsened from baseline to end of radiotherapy, then recovered to baseline levels thereafter. In multivariable analysis and after adjusting for multiple comparisons, no cardiac dose metric was significantly associated with a worsening in patient-reported physical activity, fatigue or dyspnea (p > 0.05).
CONCLUSIONS: PROs worsened from baseline to the end of thoracic chemoradiotherapy, then recovered to baseline levels. Cardiac radiation dose metrics were not associated with these changes.