由于心脏与肺部在解剖学上非常接近，加上患者中心血管危险因素的高患病率，放射引起的心脏毒性对肺癌治疗提出了重大挑战。本研究的目的是评估常规放射治疗的预测价值。可用的临床和基于成像的心脏参数来识别放射治疗（RT）后发生主要不良心脏事件（MACE）和死亡率的“高风险”患者。使用现代技术对非小细胞肺癌接受确定性放疗的患者的医疗记录对 2015 年至 2020 年期间单个中心的规划技术进行了回顾性审查。心脏事件由心脏病专家核实，死亡率数据由国家登记处确认。在 RT 计划扫描上对心脏亚结构进行自动分割，以进行回顾性结构和剂量分析，并检查它们与临床因素的相关性。使用细灰色模型来分析关系，同时考虑死亡的竞争风险。在该研究纳入的 478 名患者中，77 名患者 (16%) 出现了 88 项 MACE，中位事件发生时间为 16.3 个月。原有心脏病负担较高与 MACE 累积发生率增加相关（55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]；P < 0.001 ）。 RT 计划扫描中的左心房和左心室扩大与房性心律失常的累积发生率相关（14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]；P = 0.001 ）和心力衰竭（5 年时分别为 13% [95% CI: 8%-18%] 与 6% [95% CI: 3%-10%]；P = 0.007）。然而，心肌梗死与冠状动脉钙的存在无关（4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]；P = 0.094）。没有发现心脏成像指标在临床和统计学上与生存相关。目前的研究结果表明，心脏病史和 RT 计划扫描参数可能为前瞻性评估肺癌患者 RT 后的心脏毒性风险提供潜在的实用性。© 2024 作者。

Radiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients.The aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying "high risk" patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT).The medical records of patients who underwent definitive RT for non-small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death.Among 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; P < 0.001). Left atrial and left ventricular enlargement on RT planning scans was associated with cumulative incidence of atrial arrhythmia (14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]; P = 0.001) and heart failure (13% [95% CI: 8%-18%] vs 6% [95% CI: 3%-10%]; P = 0.007) at 5 years, respectively. However, myocardial infarction was not associated with the presence of coronary calcium (4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]; P = 0.094). No cardiac imaging metrics were found to be both clinically and statistically associated with survival.The present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.© 2024 The Authors.