Study

N

Follow-up

Type of Cancer

RT Technique (s)

RT Prescription

Major Finding (s)

Odense Univ.r Schytte, 2010

250

7.9 yrs^

NSCLC

3D-CRT

60 - 80 Gy

LV mean ≥ 14.5 Gy → ↓OS (p = 0.06)

Euro2Kr Tukenova, 2010

4122

26 yrs^

Pediatric

2D-RT

NR

Heart mean 1 Gy → ↑cardiac death excess RR 60% Heart mean 1-4.9 → ↑cardiac death RR 2.5 Heart mean 5-14.9 Gy → ↑cardiac death RR 12.5 Heart mean ≥ 15 Gy → ↑cardiac death RR 25.1

RTOG 0617ª Bradley, 2015

544

1.9 yrs^

NSCLC

3D-CRT (51.5%) IMRT (48.5%)

60 Gy (57.5%) 74 Gy (42.5%)

Heart V5 → ↓OS HR 1.007 per 1% Heart V30 → ↓OS

RTOG 0617ª Eaton, 2016

495

NR

NSCLC

3D-CRT (51.7%) IMRT (48.3%)

60 Gy (58.2%) 74 Gy (41.8%)

Heart V50 → ↑Grade 5 AE

RTOG 0617ª Chun, 2017

482

1.8 yrs^

NSCLC

3D-CRT (53%) IMRT (47%)

60 Gy (58%) 74 Gy (42%)

Heart V40 → ↓OS HR 1.01 per 1%

William Beaumontr Johnson, 2017

178

1.4 yrs^

NSCLC

3D-CRT (38.4%) IMRT (61.6%)

64 Gy^

Heart V30 → ↓OS HR 1.013 per 1%

Univ. of Manchesterr McWilliam, 2017

1101

3 - 36 mos

NSCLC

3D-CRT IMRT SBRT (7.4%)

55 Gy (non-SBRT) 60 Gy in 5 fx (SBRT)

Heart base mean > 16.3 Gy → ↓OS HR 1.25 (non-SBRT) Heart base mean > 8.5 Gy vs < 8.5 Gy → ↓OS (non-SBRT) Heart base mean > 6.3 Gy → ↓OS HR 2.11 (SBRT)

Mayo Clinic PCIr Sio, 2017

76

5.5 yrs^

Thoracic -Breast (57%) -NSCLC (17%) -Upper GI (11%)

2D-RT 3D-CRT IMRT (1.3%) SBRT (2.6%)

53.4 Gy*

Heart mean → ↓OS HR 2.01 per 1 Gy Heart mean → ↑non-cancer death HR 1.49 per 1 Gy Heart max → ↓OS after PCI HR 1.02 per 1 Gy Heart V40 → ↑non-cancer death HR 1.32 per 1%

Washington Univ.r Speirs, 2017

322

1.2 yrs^

NSCLC

3D-CRT (60%) IMRT (40%)

66 Gy^

Heart V50 → ↓OS HR 1.23 per 1% Heart V55 → ↓OS HR 1.85 per 1% (CRT only)

Multicenterr Stam, 2017

803

2.9 yrs^

NSCLC

SBRT

54 Gy in 3 fx^

LA max → ↑non-cancer death HR 1.005 per 1 Gy SVC D90 → ↑non-cancer death HR 1.025 per 1 Gy

Meta-Analysisª Taylor, 2017

40,781

10 yrs^

Breast

2D-RT

NR

Heart mean → ↑cardiac death RR 1.04 per 1 Gy

IDEAL-CRTª Vivekanandan, 2017

78

35 mos^

NSCLC

3D-CRT (“most”) IMRT (“some”)

67.7 Gy*

LA wall V63 > 2.2% → ↓OS HR 1.52

Washington Univ.r Contreras, 2018

400

17 mos^

NSCLC

3D-CRT (59%) IMRT (41%)

66 Gy^

Heart V50 → ↓OS HR 1.02 per 1%

Princess Margaretr Wong, 2018

189

35.3 mos^

NSCLC

SBRT

48 Gy in 4 fx (47.1%) 54 - 60 Gy in 3 fx (24.3%)

Ventricle max → ↑non-cancer death HR 1.02 per 1 Gy

Multicenterª Xue, 2019

94

58 mos^

NSCLC

3D-CRT

70 Gy^

Pericardium V30 > 29% → ↓OS (HR 1.019 per 1%) Pericardium V55 > 21% → ↓OS (HR 1.03 per 1%)

Dana-Farber

Atkins 2019

748

20.4 mos^

NSCLC

3D-CRT (78.1%)

IMRT (21.9%)

66 Gy^

Heart mean → ↑ACM HR 1.02 per 1 Gy

With pre-existing CHD, heart mean ≥ 10 Gy → ↑ACM HR 1.34

Without pre-existing CHD, no association between heart mean and ACM

Present Studyr Niska 2019

119

1.5 yrs^

NSCLC

3D-CRT (41.2%) IMRT (58.8%)

62 Gy^

Heart V55 → ↓OS HR 1.044 per 1% Heart V51 – V60 range predictive for OS