Dual effect of radiotherapy related concomitant cardiovascular diseases in non-small cell lung cancer

Abstract

Background: Nowadays, cancer and cardiac diseases are two of the most causes of death, so cancer treatment-related cardiac death cannot be ignored. For lung cancer, chest radiotherapy (RT) is essential, but the related cardiotoxicity has not been fully studied.

Methods: We reviewed the data of 11,455 patients with non-small cell lung cancer (NSCLC) from the Surveillance, Epidemiology, and End Results database from 2001 to 2015. The change trend for concomitant cardiovascular diseases (CVD)-specific death was calculated and graphically demonstrated. Univariate and multivariate analyses for survival were performed using Cox risk regression model.

Results: In our analysis, the overall incidence and mortality from NSCLC declined, but CVD-specific death increased. Both chemoradiotherapy and radiotherapy alone played a significant role in CVD-specific death. Analyzed longitudinally from diagnosis, we found that the effect of RT in CVD-specific death increased continuously over the third years and the hazard ratio for CVD-specific death was 1.386 times between RT and non-RT group (HR = 1.386, 95% CI 1.322-1.452; p < 0.0001). On the other hand, RT played a protective role in CVD-specific death before the second years, especially in recent years from 2013 to 2015 (HR = 0.843, 95% CI 0.740-0.959; p = 0.009).

Conclusions: Although the mortality from NSCLC decreased, but radiotherapy-related CVD-specific mortality cannot be ignored. In the long-term over 3 years, RT significantly promoted CVD-specific death. However, RT turned to be a protective role in the short-term within 2 years. In clinical practice, we need to comprehensively consider the dual effects of radiotherapy on the side effect of heart.

Keywords: cardiac deaths; epidemiology; mortality; non-small cell lung cancer; radiation therapy.