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Effect of Education and Standardization of Cardiac Dose Constraints on Heart Dose in Patients With Lung Cancer Receiving Definitive Radiation Therapy Across a Statewide Consortium.
Herr, Daniel J; Hochstedler, Kim A; Yin, Huiying; Dess, Robert T; Matuszak, Martha; Grubb, Margaret; Dominello, Michael; Movsas, Benjamin; Kestin, Larry L; Bergsma, Derek; Dragovic, Aleksandar F; Grills, Inga S; Hayman, James A; Paximadis, Peter; Schipper, Matthew; Jolly, Shruti.
Afiliação
  • Herr DJ; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
  • Hochstedler KA; Departments of Biostatistics, University of Michigan, Ann Arbor, Michigan.
  • Yin H; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
  • Dess RT; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
  • Matuszak M; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
  • Grubb M; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
  • Dominello M; Department of Radiation Oncology, Karmanos Cancer Institute, Detroit, Michigan.
  • Movsas B; Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan.
  • Kestin LL; MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, Michigan.
  • Bergsma D; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; St. Mary's Hospital, Lacks Cancer Center, Grand Rapids, Michigan.
  • Dragovic AF; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Brighton Center for Specialty Care, Brighton, Michigan.
  • Grills IS; Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan.
  • Hayman JA; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
  • Paximadis P; Department of Radiation Oncology, Spectrum Health Lakeland, St. Joseph, Michigan.
  • Schipper M; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Departments of Biostatistics, University of Michigan, Ann Arbor, Michigan.
  • Jolly S; Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: shrutij@med.umich.edu.
Pract Radiat Oncol ; 12(5): e376-e381, 2022.
Article em En | MEDLINE | ID: mdl-35121192
PURPOSE: Cardiac radiation exposure is associated with an increased rate of adverse cardiac events in patients receiving radiation therapy for locally advanced non-small cell lung carcinoma (NSCLC). Previous analysis of practice patterns within the Michigan Radiation Oncology Quality Consortium (MROQC) revealed 1 in 4 patients received a mean heart dose >20 Gy and significant heterogeneity existed among treatment centers in using cardiac dose constraints. The purpose of this study is to analyze the effect of education and initiation of standardized cardiac dose constraints on heart dose across a statewide consortium. METHODS AND MATERIALS: From 2012 to 2020, 1681 patients from 27 academic and community centers who received radiation therapy for locally advanced NSCLC were included in this analysis. Dosimetric endpoints including mean heart dose (MHD), mean lung dose, and mean esophagus dose were calculated using data from dose-volume histograms. These dose metrics were grouped by year of treatment initiation for all patients. Education regarding data for cardiac dose constraints first occurred in small lung cancer working group meetings and then consortium-wide starting in 2016. In 2018, a quality metric requiring mean heart dose <20 Gy while maintaining dose coverage (D95) to the target was implemented. Dose metrics were compared before (2012-2016) versus after (2017-2020) initiation of interventions targeting cardiac constraints. Statistical analysis was performed using the Wilcoxon rank sum test. RESULTS: After education and implementation of the heart dose performance metric, mean MHD declined from an average of 12.2 Gy preintervention to 10.4 Gy postintervention (P < .0001), and the percentage of patients receiving MHD >20 Gy was reduced from 21.1% to 10.3% (P < .0001). Mean lung dose and mean esophagus dose did not increase, and target coverage remained unchanged. CONCLUSIONS: Education and implementation of a standardized cardiac dose quality measure across a statewide consortium was associated with a reduction of mean heart dose in patients receiving radiation therapy for locally advanced NSCLC. These dose reductions were achieved without sacrificing target coverage, increasing mean lung dose, or increasing mean esophagus dose. Analysis of the clinical ramifications of the reduction in cardiac doses is ongoing.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Carcinoma Pulmonar de Células não Pequenas / Neoplasias Pulmonares Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Carcinoma Pulmonar de Células não Pequenas / Neoplasias Pulmonares Idioma: En Ano de publicação: 2022 Tipo de documento: Article