Cardiac Adverse Events Associated With Chemo-Radiation Versus Chemotherapy for Resectable Stage III Non-Small-Cell Lung Cancer: A Surveillance, Epidemiology and End Results-Medicare Study

• Published in: Journal of the American Heart Association Vol. 11; no. 23; p. e027288
• Main Authors: Herbach, Emma, O'Rorke, Michael A, Carnahan, Ryan M, McDowell, Bradley D, Allen, Bryan, Grumbach, Isabella, London, Barry, Smith, Brian J, Spitz, Douglas R, Seaman, Aaron, Chrischilles, Elizabeth A
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 06.12.2022; Wiley
• Subjects: Aged; Carcinoma, Non-Small-Cell Lung - epidemiology; Carcinoma, Non-Small-Cell Lung - therapy; cardiac effects; Cardiovascular Diseases; cardio‐oncology; epidemiology; Humans; Infant; Lung Neoplasms - epidemiology; Lung Neoplasms - therapy; Medicare; Myocardial Ischemia; non‐small‐cell lung cancer; Original Research; radiation effects; United States - epidemiology; United States; epidemiology; non‐small‐cell lung cancer; cardiac effects; radiation effects; cardio‐oncology
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.122.027288

Background We compared cardiac outcomes for surgery-eligible patients with stage III non-small-cell lung cancer treated adjuvantly or neoadjuvantly with chemotherapy versus chemo-radiation therapy in the Surveillance, Epidemiology and End Results-Medicare database. Methods and Results Patients were age 66+, had stage IIIA/B resectable non-small-cell lung cancer diagnosed between 2007 and 2015, and received adjuvant or neoadjuvant chemotherapy or chemo-radiation within 121 days of diagnosis. Patients having chemo-radiation and chemotherapy only were propensity-score matched and followed from day 121 to first cardiac outcome, noncardiac death, radiation initiation by patients who received chemotherapy only, fee-for-service enrollment interruption, or December 31, 2016. Cause-specific hazard ratios (HRs) and competing risks subdistribution HRs were estimated. The primary outcome was the first of these severe cardiac events: acute myocardial infarction, other hospitalized ischemic heart disease, hospitalized heart failure, percutaneous coronary intervention/coronary artery bypass graft, cardiac death, or urgent/inpatient care for pericardial disease, conduction abnormality, valve disorder, or ischemic heart disease. With median follow-up of 13 months, 70 of 682 patients who received chemo-radiation (10.26%) and 43 of 682 matched patients who received chemotherapy only (6.30%) developed a severe cardiac event ( =0.008) with median time to first event 5.45 months. Chemo-radiation increased the rate of severe cardiac events (cause-specific HR: 1.62 [95% CI, 1.11-2.37] and subdistribution HR: 1.41 [95% CI, 0.97-2.04]). Cancer severity appeared greater among patients who received chemo-radiation (noncardiac death cause-specific HR, 2.53 [95% CI, 1.93-3.33] and subdistribution HR, 2.52 [95% CI, 1.90-3.33]). Conclusions Adding radiation therapy to chemotherapy is associated with an increased risk of severe cardiac events among patients with resectable stage III non-small-cell lung cancer for whom survival benefit of radiation therapy is unclear.