Cardiac events in stage III non-small cell lung cancer treated in daily clinical practice.

Oncology, infection and vascular disease (English)

Juliette Degens
Maastricht University Medical Center, Respiratory Medicine
BACKGROUND
Concurrent chemo-radiotherapy (cCRT) is the preferred treatment for most stage III non-small cell lung cancer (NSCLC), with a 5 year survival of 25-35%. Recent dose-escalated radiotherapy (RT) trials report a high incidence of cardiac events in NSCLC. However, real world data on the incidence of cardiac events in NSCLC patients (pts) treated with CRT are lacking.

METHODS
The medical files of all consecutive stage III NSCLC patients treated with CRT who were included in a prospective cohort (2006-2013) were checked for cardiac events. The follow-up was 5 years. Primary endpoint was the incidence of new cardiac events with a common terminology criteria for adverse events score of ≥ 2 within five years after diagnosis. Secondary endpoint was to identify risk factors associated the development of a cardiac events.

RESULTS
Four hundred and sixty patients were included in the study. Thirty percent had a cardiac history mostly consisting of coronary artery disease (13.1%), atrial arrhythmia (7.4%) and chronic heart failure (4.2%). During follow-up 150 patients (32.6%) developed a new cardiac event with a median time to worst cardiac event of 9 months (range 0 - 60). The most common cardiac events were arrhythmia (14.6%), heart failure (7.6%) and symptomatic coronary artery disease (6.8%). Pre-existent cardiac comorbidity (hazard ratio [HR] 1.96; 95% CI 1.29 – 2.98; P<0.01) and WHO-performance-score (PS) ≥ 2 (HR 2.71; 95% CI 1.33 – 5.52; P<0.01) were significantly associated with developing a new cardiac event. Within the subgroup of pts without pre-existent cardiac comorbidity (N=311), 29.2% developed a cardiac event. In this group no significant risk factor associated with cardiac events was found.

CONCLUSION
Approximately one third of stage III NSCLC pts treated in daily clinical practice develop a new cardiac event within 5 years after CRT. Pre-existent cardiac comorbidity and WHO-PS ≥ 2 are absolute risk factors for the development of a cardiac event. Close surveillance for cardiac comorbidity and events, especially in the first year after treatment should be considered.
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