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Poster Discussion session - Non-metastatic NSCLC and other thoracic malignancies

4319 - Cardiac events in stage III non-small cell lung cancer (NSCLC) treated in daily clinical practice: is it time for cardiovascular screening and follow-up?


21 Oct 2018


Poster Discussion session - Non-metastatic NSCLC and other thoracic malignancies


Management of Systemic Therapy Toxicities;  Supportive Care and Symptom Management

Tumour Site


Juliette Degens


Annals of Oncology (2018) 29 (suppl_8): viii488-viii492. 10.1093/annonc/mdy291


J. Degens1, D. De Ruysscher2, B. Kietselaer3, G. Bootsma4, A. Schols5, A.C. Dingemans6

Author affiliations

  • 1 Department Of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, 6229 HX - Maastricht/NL
  • 2 Radiation oncology (maastro Clinic), Maastricht University Medical Centre (MUMC)-MAASTRO clinic, 6229 ET - Maastricht/NL
  • 3 Departement Of Cardiology, Zuyderland Medical Center, Geleen/NL
  • 4 Department Of Respiratory Medicine, Zuyderland Medical Center - Heerlen, 6419 PC - Heerlen/NL
  • 5 Department Of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht/NL
  • 6 Department Of Respiratory Medicine, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL

Abstract 4319


Concurrent chemo-radiotherapy (cCRT) is the preferred treatment for most stage III NSCLC, with 5 year survival of 25-35%. Recent dose-escalated radiotherapy (RT) trials report a high incidence of cardiac events (CTCAE ≥ 3 of 11 – 23%) in NSCLC. However, real world data on the incidence of cardiac events are lacking.


In this multicenter retrospective cohort study a thorough patient file search was carried out in all consecutive pts treated with (C)RT for stage III NSCLC between 2006 - 2013. The primary endpoint of this study was incidence of new cardiac event (CTCAE ≥ 2) within five years after (C)RT. Secondary we evaluated risk factors for cardiac events.


474 pts with stage III NSCLC were eligible. 391 were treated with cCRT, 69 with sequential CRT, 8 with lobectomy and/or RT and 6 are unknown. 30% of the pts had a cardiac history; mostly consisting of coronary artery disease (13.1%), atrial arrhythmia (7.4%) and chronic heart failure (4.2%). In 5 years of follow-up 151 pts (31.9%) developed a new cardiac events with a median time to event of 8 months (range 0 - 59). The most common cardiac events were arrhythmia (14.6%), heart failure (7.6%) and symptomatic coronary artery disease (6.8%). On multivariate analysis pre-existent cardiac comorbidity (hazard ratio [HR] 1.72; 95% CI 1.07 – 2.78; P = 0.02), WHO-PS ≥ 2 (HR 1.72; 95% CI 1.07 – 2.78; P = 0.03), male gender (HR 1.43; 95% CI 1.01 – 2.02; P = 0.04) and age ≥ 70 (HR 1.42; 95% CI 1.018 – 1.98; P = 0.03) were significantly associated with a cardiac event. Within the subgroup of pts without pre-existent cardiac comorbidity (N = 311), 27.1% developed a cardiac event and only age ≥ 70 was a significant predictor (HR 1.78; 95% CI 1.15 – 2.75; P = 0.01).


Approximately one third of stage III NSCLC pts treated in daily clinical practice develop a new cardiac event within 5 years after (C)RT. Pre-existent cardiac comorbidity, WHO-PS ≥ 2, age ≥ 70 and male gender are absolute risk factors for the development of a cardiac event. Because cardiac events cause a high burden of morbidity and can influence quality of life, screening for cardiac comorbidity and events, especially in the first year after treatment should be considered.

Clinical trial identification

Legal entity responsible for the study

Maastricht University Medical Center (MUMC+).


Has not received any funding.

Editorial Acknowledgement


A-M.C. Dingemans: Other from Roche/Genentech, MSD Oncology, AstraZeneca, Pfizer, Lilly, other from Boehringer Ingelheim, Bristol-Myers Squibb, Clovis Oncology, outside the submitted work. All other authors have declared no conflicts of interest.

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