Title

Cardiac and pulmonary dosimetric parameters in lung cancer patients undergoing post-operative radiation therapy across a state-wide consortium

Authors

Daniel J. Herr
Huiying Yin
Steven G. Allen
Derek Bergsma
Aleksandar F. Dragovic
Robert T. Dess
Martha Matuszak
Margaret Grubb
Michael Dominello
Benjamin Movsas, Henry Ford HealthFollow
Larry L. Kestin
James A. Hayman
Peter Paximadis
Matthew Schipper
Shruti Jolly

Recommended Citation

Herr DJ, Yin H, Allen SG, Bergsma D, Dragovic AF, Dess RT, Matuszak M, Grubb M, Dominello M, Movsas B, Kestin LL, Hayman JA, Paximadis P, Schipper M, and Jolly S. Cardiac and pulmonary dosimetric parameters in lung cancer patients undergoing post-operative radiation therapy across a state-wide consortium. Pract Radiat Oncol 2023.

Document Type

Article

Publication Date

2-6-2023

Publication Title

Pract Radiat Oncol

Abstract

PURPOSE/OBJECTIVES: The recently published Lung ART trial reported increased rates of cardiac and pulmonary toxicity in the post-operative radiation therapy (PORT) arm. It remains unknown whether the dosimetric parameters reported in Lung ART are representative of contemporary real-world practice, which remains relevant for patients undergoing post-operative RT for positive surgical margins. The purpose of this study is to examine heart and lung dose exposure in patients receiving post-operative radiation therapy for non-small cell lung cancer (NSCLC) across a statewide consortium.

MATERIALS/METHODS: From 2012 to 2022, demographic and dosimetric data were prospectively collected for 377 patients at 27 academic and community centers within [redacted] undergoing PORT for non-metastatic NSCLC. Dosimetric parameters for target coverage and Organ at Risk (OAR) exposure were calculated using data from dose volume histograms, and rates of 3D-CRT and IMRT utilization were assessed.

RESULTS: Fifty-one percent of patients in this cohort had N2 disease at the time of surgery, 25% had a positive margin. Sixty-six percent of patients were treated with IMRT compared to 32% with 3D-CRT. Planning target volume (PTV) was significantly smaller in patients treated with 3D-CRT (149.2 cc vs. 265.4 cc, p<0.0001). Median mean heart dose for all patients was 8.7 Gy (IQR 3.5, 15.3), median heart V5 was 35.2% (IQR 18.5, 60.2) and median heart V35 was 9% (IQR 3.2, 17.7). Median mean lung dose (MLD) was 11.4 Gy (IQR 8.1, 14.3), median lung V20 was 19.6% (IQR 12.7, 25.4). These dosimetric parameters did not significantly differ by treatment modality (IMRT vs. 3D-CRT) or in patients with positive vs. negative surgical margins.

CONCLUSIONS: With increased rates of IMRT use, cardiac and lung dosimetric parameters in this state-wide consortium are slightly lower than those reported in Lung ART. These data provide useful benchmarks for treatment planning in patients undergoing post-operative RT for positive surgical margins.

PubMed ID

36754278

ePublication

ePub ahead of print