3595 - Relationship between Effective Dose to Immune Cells and Cardiopulmonary Toxicity in Locally Advanced NSCLC
Presenter(s)
Y. Qin1,2, P. Li2, X. Liu2, A. Jiang2, X. Liang3, J. Yu2, J. Yuan2, B. Tian2, F. Wang4, Y. Xu4, Y. Mo2,5, and D. Chen1,2; 1Shandong University Cancer Center, Jinan, Shandong, China, 2Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China, 3Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China, 4Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China, 5The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
Purpose/Objective(s): The hypothesis is that higher effective dose to immune cells (EDIC) is associated with increased rates of grade =3 cardiotoxicity (CTox) and pulmonary toxicity (PTox) in patients with locally advanced non-small cell lung cancer (NSCLC). This study aims to investigate the correlation between EDIC and treatment-related CTox and PTox in this patient population.
Materials/Methods: This retrospective cohort study enrolled patients with stage III, unresectable NSCLC who received concurrent chemoradiotherapy followed by consolidation immunotherapy at one institution between March 2019 and December 2023. Data were sourced from electronic medical records and the Eclipse Treatment Planning System. The primary outcomes were CTox and PTox, while secondary outcomes included acute hematologic toxicity (HTox). Toxicities were graded per Common Terminology Criteria for Adverse Events v5.0. The EDIC was calculated using a modified model incorporating mean lung dose (MLD), mean heart dose (MHD), mean body dose (MBD), and the number of fractions (n). Patients were divided into high and low EDIC groups based on the median value. Survival analyses using Kaplan-Meier estimates and Cox proportional-hazards models were employed to evaluate the association between EDIC (as both a continuous and categorical variable) and the development of CTox and PTox. Logistic regression was used to assess the relationship between EDIC and acute HTox. All tests were two-sided, with statistical significance set at P < 0.05.
Results: A total of 138 patients were included, with a median EDIC of 4.73Gy. Compared to the EDIC < 4.73Gy group, the EDIC = 4.73Gy group had a significantly higher incidence of = grade 3 (G3) CTox (40.58% vs 17.39%, P = 0.001) and = G3 PTox (27.54% vs 4.35%, P = 0.001). Cox regression analysis further confirmed that, after full adjustment for confounders, continuous EDIC was significantly associated with the occurrence of = G3 CTox (HR 1.382, 95% CI 1.119–1.707, P = 0.003) and = G3 PTox (HR 1.521, 95% CI 1.129–2.048, P = 0.006). Myocarditis was the most common type of CTox, occurring in 44 patients (31.88%), and Kaplan-Meier analysis showed that myocarditis was significantly associated with poorer overall survival (P = 0.006). Additionally, multivariate logistic regression revealed that = G3 acute HTox was an independent risk factor for = G3 cardiopulmonary toxicity (OR 3.814, 95% CI 1.381–10.532, P = 0.010).
Conclusion: EDIC can predict CTox and PTox. EDIC may lead to cardiopulmonary toxicity through = G3 HTox, potentially affecting patient survival. The results highlight the importance of optimizing radiotherapy plans to reduce EDIC.