Heart dose linked with cardiac events and overall survival in lung cancer radiotherapy: A meta-analysis. Issue 38 (18th September 2020)

• Record Type: Journal Article
• Authors: Pan, Li; Lei, Dengshun; Wang, Wenbing; Luo, Yanqiu; Wang, Dan
• Other Names: Insalaco. Giuseppe section editor.
• Is Part Of: Medicine. Volume 99:Issue 38(2020)
• Publication Date: 2020-09-18
• Subjects: heart dose -- lung cancer -- overall survival -- radiation-induced heart disease; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000021964
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Background: The aim of this study was to investigate the link between heart dose and overall survival, the link between heart dose and cardiac events and whether radiation-induced heart diseases were associated with overall survival in lung cancer radiotherapy. Methods: We performed a literature search by using Pubmed, Embase, China National Knowledge Infrastructure (CNKI) databases. Pairs of reviewers independently screened literature according to the inclusion criteria, extracted data, assessed methodological quality, and publication bias. The primary end points included overall survival and cardiac events. I 2 was calculated in a heterogeneity assessment. Publication bias was evaluated by using Begg funnel plot and Egger test. Results: Ten studies including 1 randomized controlled trial, 3 post hoc analysis of prospective trials, and 6 cohort studies were identified. The meta-analysis showed that heart volume receiving ≥5 Gy (HV5) (hazard ratio [HR] = 1.01; 95% confidence interval [CI]: 1.00–1.01), heart volume receiving ≥30 Gy (HV30) (HR = 1.01; 95% CI: 1.00–1.02), heart volume receiving ≥50 Gy (HV50) (HR = 1.05; 95%CI: 1.00–1.10), and mean heart dose (MHD) (HR = 1.01; 95%CI:1.00–1.02) all were associated with worse overall survival. In addition, the MHD (HR = 1.03; 95% CI: 1.02–1.05), HV5 (HR = 1.02; 95% CI: 1.01–1.03), and HV30 (HR = 1.02; 95% CI: 1.01–1.03) were significantly associated with all grade cardiac events. Meanwhile, compared with those who did not receive radiotherapy, the radiotherapy group experienced a significantly increased risk for cardiac-specific mortality (HR = 1.297; 95% CI: 1.213–1.387). However, the results did not show that cardiac events were associated with overall survival in lung cancer radiotherapy (HR = 1.472; 95% CI: 0.988–2.193). Conclusion: Exposure of the heart to radiation increased the risk of cardiac events during radiotherapy for lung cancer. Meanwhile, heart dose including HV5 and HV30 were predictors of overall survival in lung cancer radiotherapy. It is necessary to constrain the heart dose when perform thoracic radiation therapy to decrease the incidence of cardiac events and improve the overall survival.