Association of Heart Base Dose With Overall Survival in Patients With NSCLC Undergoing Postoperative Radiotherapy

We read with interest the study conducted by McWilliam et al. 1 McWilliam A. Abravan A. Banfill K. Faivre-Finn C. Van Herk M. Demystifying The results of RTOG 0617: identification of dose sensitive cardiac subregions associated with overall survival. J Thorac Oncol. 2023; 18: 599-607 Abstract Full Text Full Text PDF Scopus (2) Google Scholar The study revealed that heart base dose was associated with overall survival (OS) in patients with lung cancer undergoing definitive radiotherapy. We also conducted a study evaluating the effect of heart dose on OS, which enrolled 307 patients with NSCLC undergoing postoperative radiotherapy (PORT) from the PORT-C randomized controlled trial 2 Hui Z. Men Y. Hu C. et al. Effect of postoperative radiotherapy for patients with PIIIa-N2 non-small cell lung cancer after complete resection and adjuvant chemotherapy: the phase 3 port-C randomized clinical trial. Jama Oncol. 2021; 7: 1178-1185 Crossref PubMed Scopus (88) Google Scholar and the retrospective database in the National Cancer Center of China. We want to share our results and the following thoughts. Demystifying the Results of RTOG 0617: Identification of Dose Sensitive Cardiac Subregions Associated With Overall SurvivalJournal of Thoracic OncologyVol. 18Issue 5PreviewThe RTOG 0617 trial presented a worse survival for patients with lung cancer treated in the high-dose (74 Gy) arm. In multivariable models, radiation level and whole-heart volumetric dose parameters were associated with survival. In this work, we consider heart subregions to explain the observed survival difference between radiation levels. Full-Text PDF Open AccessReply to the Letter by Ma et alJournal of Thoracic OncologyVol. 18Issue 6PreviewWe thank the editor for the invitation to reply to the letter received from Dr. Ma et al. We also note with interest that the authors have recently published the full version of the analysis they reference in the letter in Advances in Radiation Oncology: “Higher lung and heart doses decrease early and long-term survival respectively in patients with non–small cell lung cancer undergoing postoperative radiotherapy.”1 We explored the methodology presented in this article relating to their statement “we found that heart V50 (heart volume receiving ≥50 Gy) was associated with OS (Hazard ratio, HR = 1.07 (95% CI: 1.02-1.12), P = 0.008).” First, we note that this result was on the basis of univariable analysis, and does not consider the tumor volume (or planning target volume) which will affect survival through tumor burden and driving higher heart dose. Full-Text PDF