Sinoatrial Node Dose Is Associated With Worse Survival in Patients Undergoing Definitive Stereotactic Body Radiation Therapy for Central Lung Cancers.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 37804882.
- Also identified by DOI 10.1016/j.prro.2023.09.005.
- No licence information is recorded for this record.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
Our purpose was to evaluate the clinical consequences of sinoatrial node (SAN) and atrioventricular node (AVN) irradiation in patients undergoing stereotactic body radiation therapy (SBRT) for central non-small cell lung cancer (NSCLC) tumors. A single-institutional retrospective review of patients with primary NSCLC undergoing definitive SBRT for centrally located thoracic tumors from February 2007 to December 2021 was performed. The SAN and AVN were contoured in accordance with a published contouring atlas, and the maximum dose (D<sub>max</sub>) and mean dose (D<sub>mean</sub>) for each structure were calculated. Sequential log rank testing between the 50th and 90th percentiles was used to identify potential cutoff values for the corresponding dosimetric parameters and overall survival. Among 93 eligible patients, the median age was 72.5 years (IQR, 66.6-78.3), and median follow-up was 32.4 months (IQR, 13.0-49.6). The median SAN D<sub>max</sub> and D<sub>mean</sub> were 95 cGy (range, 9-5394) and 58 cGy (range, 7-3168), respectively. The median AVN D<sub>max</sub> and D<sub>mean</sub> were 45 cGy (range, 4-2121) and 34 cGy (range, 3-1667), respectively. Candidate cutoff values for SAN D<sub>max</sub> and D<sub>mean</sub> were 1309 and 836 cGy, respectively. No associations between AVN parameters and survival outcomes were identified. Upon multivariate Cox regression, the SAN D<sub>max</sub> cutoff (hazard ratio [HR], 2.03 [1.09-3.79]; P = .026) and SAN D<sub>mean</sub> cutoff (HR, 2.22 [1.20-4.12]; P = .011) were significantly associated with overall survival. For noncancer-associated survival, the SAN D<sub>max</sub> cutoff trended toward significance (HR, 2.02 [0.89-4.57]; P = .092), and the SAN D<sub>mean</sub> cutoff remained significantly associated (HR, 2.34 [1.05-5.18]; P = .037). For patients undergoing SBRT for NSCLC, SAN D<sub>max</sub> and D<sub>mean</sub> were significantly associated with worse overall survival using cut-off values of 1309 and 836 cGy, respectively. Further studies examining the effect of SAN irradiation during SBRT are warranted.
Medical subject headings
- Lung Neoplasms
- Carcinoma, Non-Small-Cell Lung
- Radiosurgery