2492 - Cardiac Risk, Outcomes, and Management among Older Adults with Stage I-II NSCLC Undergoing Stereotactic Body Radiation Therapy
Presenter(s)
L. L. Thompson1,2, S. Shah1,2, A. T. Gregg1,2, J. Yoon1,2, C. Florissi1,2, P. M. Amin1,2, S. M. Lipson1,2, N. Anabaraonye1,2, S. Jiang1,2, E. Baxter1,2, N. A. Saeed1,2, A. Saraf1, C. V. Guthier1,2, A. Warrington1, K. M. Atkins3, R. B. Jimenez4, and R. H. Mak2,5; 1Dana-Farber Brigham Cancer Center, Boston, MA, 2Harvard Medical School, Boston, MA, 3Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 4Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, 5Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
Purpose/Objective(s): Older adults with early-stage non-small cell lung cancer (NSCLC) undergoing stereotactic body radiation therapy (SBRT) often have high competing risk of adverse cardiac events. Despite this, adherence to guideline-directed cardiovascular care remains unclear. Therefore, this study evaluates cardiac risk, outcomes, and management among older adults with early-stage NSCLC receiving SBRT.
Materials/Methods: This IRB-approved retrospective cohort study (Protocol No. 11-286) included patients aged =65 with early-stage NSCLC who completed SBRT 01/01/19-03/31/23. We assessed: (1) 10-year atherosclerotic cardiovascular disease (ASCVD) risk using a validated cardiovascular risk calculator derived from Framingham data incorporating age, sex, systolic blood pressure (SBP), smoking, diabetes, and body mass index, (2) rates of post-SBRT major adverse cardiac events (MACE), (3) prevalence of guideline-directed medical management for hypertension, hyperlipidemia, and diabetes, and (4) engagement with primary care and cardiology services in the year pre- and post-SBRT.
Results: Among 330 patients (median age 77.1 years, 61.8% female), 98.5% had cardiovascular comorbidities, including hypertension (88.2%) and hyperlipidemia (86.4%). At SBRT initiation, 30.6% had prior ASCVD (coronary heart disease, cerebrovascular disease, peripheral artery disease, or aortic atherosclerosis), and 91.8% were at high or very high risk for future events by history or calculated risk score. Common SBRT regimens included 55-60 Gy/5 Fx (42.1%), 54 Gy/3 Fx (41.5%), 50 Gy/5 Fx (12.4%); 27.0% of patients had a total coronary V15 exceeding 2 cc and median mean heart dose was 57.0 cGy (IQR 14.4-218.1 cGy). Post-SBRT, at a median follow-up time of 21.2 months (IQR 12.8-33.6 months, range 1.9-55.3 months), 17.3% (57/330) patients experienced MACE (unstable angina, heart failure hospitalization or urgent visit, myocardial infarction, coronary revascularization, or cardiac death). Guideline-directed medical management was infrequent: 45.7% for hypertension, 28.7% for hyperlipidemia, and 30.3% for diabetes. More than half of the patients (54.5%) had no primary care or cardiology visits pre-SBRT, and 55.8% had no visits of these types post-SBRT.
Conclusion: Older adults undergoing SBRT for NSCLC face substantial cardiovascular risk, yet many do not receive appropriate preventive care. The high MACE rates observed post-SBRT highlight the need for improved risk stratification and integrated management strategies.