CP6 – Improves Radiotherapy

Improved Radiotherapy and medical treatment

Tine Schytte, overlæge, onkologisk afdeling, Odense Universitetshospital

Projekt 2: Identifying parameters influencing loco-regional control and overall survival

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Projekt 1: Forekomsten af hjertesygdom som følge af strålebehandling hos patienter med lunge- og spiserørskræft i Danmark

Status oktober 2023
Subproject1: Heart disease caused by Radiotherapy
As overall survival increases, it is essential to minimize radiation-induced side effects. Side effects caused by irradiation of the heart during RT of lung cancer is not well described, but data from lymphoma and breast cancer show increased heart disease and heart-related mortality after radiotherapy. In this subproject, a PhD project investigates heart disease for patients with locally advanced lung cancer (LA_NSCLC). It is investigated if pre-treatment risk factors (coronary artery calcium score) is correlated to survival in patients with LA_NSCLC as a high calcium score is known to predict survival and heart disease in a general patient population. This knowledge will enable monitoring, early detection and treatment of heart disease for high risk patients thereby improving their outcome. The analyses is based on data from 644 Danish patients with LA_NSCLC treated at OUH (127), AUH (138), Vejle (126), RH (106), Herlev (90), and Aalborg (57).

Subproject 2: Identifying parameters influencing loco-regional control and overall survival
Relating pre-treatment parameters to the risk of failure in terms of either loco-regional or distant recurrence after radiotherapy will enable patient-specific risk-adapted treatment strategies, where i.e. patients prone to fail loco-regionally will receive intensified radiotherapy treatment. Based on data from Rigshospitalet a competing risk model for first site of failure after definitive chemoradiotherapy for inoperable NSCLC was published [J Thorac Oncol. 2018 13:559-567]. The model uses pre-treatment performance status (PS), stage, histology, concomitant chemotherapy, gender, age, tumor size, SUVpeak of the primary tumor, and the lymph nodes with the highest uptake to predict the type of failure or death. In this study, we have validated the published model in an independent external cohort from Aarhus University Hospital. The large difference in the pattern of failure for patients with different histologies was confirmed. The study is being prepared for publication.

Subproject 3: Analysis of the primary endpoint in the NARLAL2 trial
The randomized phase III NARLAL2 trial has included the final patient in march 2023. Patients from Aarhus, Vejle, Odense, Herlev, and RH were included in the trial. The primary endpoint (loco-regional tumor control) and outcome in terms of overall survival and early toxicity will be published in two papers in 2024.

Does Coronary artery calcium score have an impact on overall survival for locally advanced non-small cell lung cancer treated with definitive radiotherapy. A Olloni, C Brink, EL Lorenzen, SS Jeppesen, L Hofmann, C Kristiansen, MM Knap(, DS Møller, L Nygård, GF Persson, RS Thing, HM Sand, A Diederichsen, T Schytte. DOI: 10.1016/j.radonc.2023.109719

An open source auto-segmentation algorithm for delineating heart and substructures – Development and validation within a multicenter lung cancer cohort. A Olloni, EL Lorenzen, S Jeppesen, A Diederichsen, R Finnegan, L Hoffmann, C Kristiansen, MM Knap, MLH Milo, D Møller, L Nygård, G Persson, HMB Sand, N Sarup, R Thing, C Brink, T Schytte. DOI:10.1016/j.radonc.2023.110065

Heart and Lung Dose as Predictors of Overall Survival in Patients with Locally Advanced Lung Cancer. A National Multicenter study. Olloni A, Brink C, Lorenzen EL, Jeppesen SS, Hoffmann L, Kristiansen C, Knap MM, Møller DS, Nygård L, Persson GF, Thing, RS, Sand HMS, Diederichsen A, Schytte T. Submitted to Journal og Thoracic Oncology