Effect of education and standardization of cardiac dose constraints on heart dose in lung cancer patients receiving definitive radiation therapy across a statewide consortium.
Practical radiation oncology
PURPOSE/OBJECTIVES: Cardiac radiation exposure is associated with an increased rate of adverse cardiac events in patients receiving radiation therapy for locally advanced non-small cell lung carcinoma (NSCLC). Previous analysis of practice patterns within XXXX revealed 1 in 4 patients received a mean heart dose >20 Gy and significant heterogeneity existed among treatment centers in using cardiac dose constraints. The purpose of this study is to analyze the effect of education and initiation of standardized cardiac dose constraints on heart dose across a statewide consortium.
MATERIALS/METHODS: From 2012 to 2020, 1681 patients from 27 academic and community centers who received radiation therapy for locally advanced NSCLC were included in this analysis. Dosimetric endpoints including mean heart dose (MHD), mean lung dose, and mean esophagus dose were calculated using data from dose-volume histograms. These dose metrics were grouped by year of treatment initiation for all patients. Education regarding data for cardiac dose constraints first occurred in small lung cancer working group meetings and then consortium-wide starting in 2016. In 2018, a quality metric requiring mean heart dose(D95) to the target was implemented. Dose metrics were compared before (2012-2016) versus after (2017-2020) initiation of interventions targeting cardiac constraints. Statistical analysis was performed using the Wilcoxon Rank Sum test.
RESULTS: Following education and implementation of the heart dose performance metric, mean MHD declined from an average of 12.2 Gy pre-intervention to 10.4 Gy post-intervention (p < 0.0001), and the percentage of patients receiving MHD >20 Gy reduced from 21.1% to 10.3% (p < 0.0001). Mean lung dose and mean esophagus dose did not increase, and target coverage remained unchanged.
CONCLUSIONS: Education and implementation of a standardized cardiac dose quality measure across a statewide consortium was associated with a reduction of mean heart dose in patients receiving radiation therapy for locally advanced NSCLC. These dose reductions were achieved without sacrificing target coverage, increasing mean lung dose, or increasing mean esophagus dose. Analysis of the clinical ramifications of the reduction in cardiac doses is ongoing.
Herr DJ, Hochstedler KA, Yin H, Dess RT, Matuszak M, Grubb M, Dominello M, Movsas B, Kestin LL, Bergsma D, Dragovic AF, Grills IS, Hayman JA, Paximadis P, Schipper M, Jolly S; Michigan Radiation Oncology Quality Consortium. Effect of education and standardization of cardiac dose constraints on heart dose in lung cancer patients receiving definitive radiation therapy across a statewide consortium. Pract Radiat Oncol. 2022 Feb 1:S1879-8500(22)00007-8. doi: 10.1016/j.prro.2022.01.002. Epub ahead of print. PMID: 35121192.