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Association of Sinoatrial Node Radiation Dose With Atrial Fibrillation and Mortality in Patients With Lung Cancer

 Kyung Hwan Kim  ;  Jaewon Oh  ;  Gowoon Yang  ;  Joongyo Lee  ;  Jihun Kim  ;  Seo-Yeon Gwak  ;  Iksung Cho  ;  Seung Hyun Lee  ;  Hwa Kyung Byun  ;  Hyo-Kyoung Choi  ;  Jinsung Kim  ;  Jee Suk Chang  ;  Seok-Min Kang  ;  Hong In Yoon 
 JAMA ONCOLOGY, Vol.8(11) : 1624-1634, 2022-11 
Journal Title
Issue Date
Aged ; Atrial Fibrillation* / complications ; Atrial Fibrillation* / epidemiology ; Atrial Fibrillation* / physiopathology ; Carcinoma, Non-Small-Cell Lung* / complications ; Cohort Studies ; Female ; Heart Rate ; Humans ; Lung Neoplasms* / complications ; Male ; Radiation Dosage ; Retrospective Studies ; Sinoatrial Node / physiopathology
Importance: Atrial fibrillation (AF) can develop following thoracic irradiation. However, the critical cardiac substructure responsible for AF has not been properly studied.

Objective: To describe the incidence of AF in patients with lung cancer and determine predictive cardiac dosimetric parameters.

Design, setting, and participants: This retrospective cohort study was performed at a single referral center and included 239 patients diagnosed with limited-stage small cell lung cancer (SCLC) and 321 patients diagnosed with locally advanced non-small cell lung cancer (NSCLC) between August 2008 and December 2019 who were treated with definitive chemoradiotherapy.

Exposures: Radiation dose exposure to cardiac substructures, including the chambers, coronary arteries, and cardiac conduction nodes, were calculated for each patient.

Main outcomes and measures: Main outcomes were AF and overall survival.

Results: Of the 239 and 321 patients with SCLC and NSCLC, the median (IQR) age was 68 (60-73) years and 67 (61-75) years, and 207 (86.6%) and 261 (81.3%) were men, respectively. At a median (IQR) follow-up time of 32.7 (22.1-56.6) months, 9 and 17 patients experienced new-onset AF in the SCLC and NSCLC cohorts, respectively. The maximum dose delivered to the sinoatrial node (SAN Dmax) exhibited the highest predictive value for prediction of AF. A higher SAN Dmax significantly predicted an increased risk of AF in patients with SCLC (adjusted hazard ratio [aHR], 14.91; 95% CI, 4.00-55.56; P < .001) and NSCLC (aHR, 15.67; 95% CI, 2.08-118.20; P = .008). However, SAN Dmax was not associated with non-AF cardiac events. Increased SAN Dmax was significantly associated with poor overall survival in patients with SCLC (aHR, 2.68; 95% CI, 1.53-4.71; P < .001) and NSCLC (aHR, 1.97; 95% CI, 1.45-2.68; P < .001).

Conclusions and relevance: In this cohort study, results suggest that incidental irradiation of the SAN during chemoradiotherapy may be associated with the development of AF and increased mortality. This supports the need to minimize radiation dose exposure to the SAN during radiotherapy planning and to consider close follow-up for the early detection of AF in patients receiving thoracic irradiation.
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1. College of Medicine (의과대학) > Dept. of Biochemistry and Molecular Biology (생화학-분자생물학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Kim, Kyung Hwan(김경환)
Kim, Jihun(김지훈) ORCID logo https://orcid.org/0000-0003-4856-6305
Kim, Jinsung(김진성) ORCID logo https://orcid.org/0000-0003-1415-6471
Byun, Hwa Kyung(변화경) ORCID logo https://orcid.org/0000-0002-8964-6275
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
Yoon, Hong In(윤홍인) ORCID logo https://orcid.org/0000-0002-2106-6856
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0001-7549-9430
Lee, Joongyo(이준교)
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Cho, Ik Sung(조익성)
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