Short summary

Curatively intended radiotherapy is a treatment option, for patients with loco-regionally advanced non-small cell lung cancer and esophageal cancer. While the acute toxicities of radiotherapy are known, the late side-effects as cardiac toxicity are not well described in this patient group. Detection of coronary artery calcium with computerised tomography (CT) has proven to be a reliable marker for cardiovascular events.

Rationale

Curatively intended radiotherapy(RT) is a treatment option for patients in good performance status with loco-regionally advanced non-small cell lung cancer (NSCLC) and esophageal cancer (EC). The 5 year cure rates are15-30% depending on the stage of the cancer and patient related conditions. During the last 10 years the survival has luckily being increasing, this creates a need to focus on potential toxicities on a longer term than a few years. Due to the location of the heart in the thorax, irradiation of the lungs and the esophagus invariably involves some RT dose to the heart. Increased cardiac mortality rates have been demonstrated subsequent to RT for Hodgkin´s lymphoma and breast cancer, but little is known about cardiac mortality in survivors from NSCLC and EC. Detection and quantification of the presence of coronary artery calcium (CAC) with computerised tomography (CT) has proven to be a reliable biomarker for cardiovascular events in non cancer patients. In current studies CAC is an independent factor that adds superior to the traditionally risk factors. In the Danish Lung Cancer Screening Trial, CAC was a robust prognostic measure of fatal or non-fatal cardiovascular events. Accumulating evidence suggests that administration of statins to high risk patients may reduce not only the risk of cardiovascular disease, but also reduce the risk of dying from cancer.

In this project, the following questions will be adressed:

1. Does a high CACs prior to RT have a prognostic survival effect among patients irradiated for NSCLC and EC?

2. Is an increase in CACs after RT associated with higher mortality in patients irradiated for NSCLC and EC?

3. Does treatment with statins have a favorable influence on survival in NSCLC- and EC patients with high CACs treated with definitive RT?

4. Can early and late toxicity to the heart be detected by cardiac imaging using echocardiography of the heart, cardiac magnetic resonance and electrocardiogram?

Description of the cohort

Cohort 1: Patients with non-small cell lung cancer and esophageal cancer treated in Denmark, with definitive radiotherapy (e.g. curative intent) in years 2014 and 2015. Studies 1-3.

Cohort 2: Patients with non-small cell lung cancer treated with definitive radiotherapy 2014-2020 at Odense University Hospital. Study 4.

Data and biological material

Studies 1-3: Mainly register from The Danish Health Data Authority, combined with information, from radiotherapy planning module and CT scans, where the CACs will be assesed.

Study 4: Clinical data consisting of: Patien characheristics (Age, BMI, gender and performance status) Tumor charachteristics (stage and histology) Treatment (chemoherapy, radiotherapy, surgery) Performed scans CT, MR and echocardiography.

Collaborating researchers and departments

Department of Oncology, Odense University Hospital

• Consultant, Associate Professor, PhD Tine Schytte
• Consultant, Associate Professor, PhD Stefan Starup Jeppesen
• Medical Physicist, Professor, PhD Carsten Brink

Department of Cardiology, Odense University Hospital

• Consultant, Professor, PhD Axel Diederichsen