Topics:
Radiation Oncology • Thoracic Malignancies
What heart dose constraint should be used when treating locally advanced NSCLC?
Do you use V5, V30 (as per Dess, JCO 2017)? V50 (Speirs, JTO 2017)? Mean (Wang JCO 2017)? What is the most evidence based criteria? How do you balance the risk of cardiac toxicity with the risk of undertreatment of lung cancer?
https://www.ncbi.nlm.nih.gov/pubmed/28301264
https://www.ncbi.nlm.nih.gov/pubmed/27743888
https://www.ncbi.nlm.nih.gov/pubmed/28113017
Answer from: Radiation Oncologist at Academic Institution
I use V50 <25%, then again I was the senior author on one of those 3 papers, so I'm a bit biased! To be clear, though, I think the punchline here is that the metric being use is fundamentally less important than just using a metric that is more stringent than the historic constraints. It is we...
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Answer from: Radiation Oncologist at Academic Institution
Based on pooled data from UNC dose-escalation trials have been using a mean heart dose of <20Gy, as this correlated with <10% risk of cardiac event (with little difference between <10Gy and 10-20Gy, risk of cardiac events 4% versus 7%) while once mean heart dose exceeds 20Gy, the risk of ca...