Proton Therapy to Reduce Heart Damage for Lung Cancer Patients

质子治疗可减少肺癌患者的心脏损伤

• 批准号: 10017671
• 负责人: ZHONGXING LIAO
• 金额: $ 17.62万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-17 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017671
• 关键词: 3-Dimensional; Accounting; Acute; Affect; Aftercare; Attention; Autonomic Dysfunction; Biological Assay; Biological Markers; Blood specimen; Breast Lymphoma; Cancer Patient; Cardiac; Cardiac Death; Cardiac Myocytes; Cardiology; Cardiotoxicity; Cause of Death; Cessation of life; Chemotherapy and/or radiation; Chest; Clinical; Clinical Treatment; Conformal Radiotherapy; Data; Dependence; Deposition; Development; Diagnosis; Diagnostic radiologic examination; Disease; Dose; Drops; Enrollment; Event; Exposure to; Future; General Hospitals; Goals; Heart; Heart Diseases; Heart Rate; Hodgkin Disease; Hypersensitivity; Image; Intensity modulated proton therapy; Intensity-Modulated Radiotherapy; Knowledge; Lead; Length; Location; Longevity; Longitudinal Studies; Lung; Malignant Neoplasms; Malignant neoplasm of esophagus; Malignant neoplasm of lung; Malignant neoplasm of thorax; Massachusetts; Measures; Mediastinal lymph node group; Modeling; Monitor; Non-Small-Cell Lung Carcinoma; Patient Selection; Patients; Pattern; Photons; Positron-Emission Tomography; Proton Radiation; Protons; Radiation; Radiation Oncologist; Radiation therapy; Randomized Clinical Trials; Rest; Risk; Roentgen Rays; Sampling; Serum; Structure; Survival Rate; System; Time; Tissues; Translating; Troponin T; Tumor Tissue; Work; cancer site; cardioprotection; clinical practice; comparative; cost; dosimetry; heart damage; high risk; improved; innovation; interest; irradiation; malignant breast neoplasm; myocardial damage; particle beam; phase 3 study; premature; prevent; prospective; proton therapy; radiation delivery; radiation effect; radiological imaging; randomized trial; standard of care; tool; treatment planning; trial comparing; tumor

PROJECT SUMMARY/ABSTRACT The relationship between radiation therapy to the thorax and heart damage has been established through long-term studies of patients with breast cancer and Hodgkin lymphoma as cardiac disease became the primary non-cancer cause of death among such patients. Clinical treatments for both diseases have been adjusted to minimize radiation heart exposure by simple shielding and technical advances. For patients with locally advanced lung cancer, meaning that the mediastinal lymph nodes directly behind the heart are already involved with cancer, it is extremely difficult to avoid heart exposure during treatment owing to the physical location of the tumor. Yet little attention has been paid to this problem because of the assumption that radiation-induced cardiac damage is problematic only for patients who live longer than 5 years after their diagnosis. This excludes the vast majority of lung cancer patients, as their longevity with the current standard of care is estimated in the range of 18-24 months. This assumption that radiation causes only late- onset cardiac problems has been recently called into question. A recent phase III study suggested that poor survival rates of lung cancer patients may reflect the amount of heart tissue that is inadvertently exposed to radiation during treatment, which may cause premature death. We recently completed a randomized trial comparing protons and photons for lung cancer patients and found that proton therapy can significantly reduce unwanted radiation to the heart. However, we have not investigated if the reduction of radiation to the heart has reduced heart damage, nor if the reduction in heart exposure can translate to improved survival in patients with lung cancer. Damaged heart tissue releases cardiac troponin T (TnT), which is used widely in cardiology to diagnose and monitor heart damage after chemotherapy and radiation for breast cancer or lymphoma. Damaged heart tissue can also be visualized and quantified by PET scans. In this proposal, we will determine if reduced heart exposure to radiation by proton therapy can indeed reduce heart damage due to radiation in lung cancer patients. We will also determine if the reduced heart damage will improve the survival of these patients. Both of these goals will be analyzed by using a highly sensitive assay for cardiac TnT and the changes on the PET images from samples collected during the course of a completed randomized clinical trial. We will also investigate if certain heart structures are more sensitive to radiation by leveraging detailed dosimetry of implemented treatment plans. While this proposal carries risk that no cardiac benefit will be found after proton radiation, it also carries the potential of significant clinical impact as it could lead to practice-changing findings.

项目摘要/摘要 通过 作为心脏病的乳腺癌和霍奇金淋巴瘤患者的长期研究成为 此类患者的主要非癌症死亡原因。两种疾病的临床治疗已经 通过简单的屏蔽和技术进步来调整以最大程度地减少辐射心脏的暴露。适用于患者 局部晚期肺癌，这意味着直接在心脏后面的纵隔淋巴结 由于已经参与癌症，由于 肿瘤的物理位置。然而，由于这个问题，很少关注这个问题 辐射引起的心脏损伤仅对超过5年的患者有问题 他们的诊断。这不包括绝大多数肺癌患者，因为他们的寿命与当前 估计在18-24个月的范围内估计护理标准。这个假设辐射仅导致晚期 发作心脏问题最近受到质疑。最近的第三阶段研究表明差 肺癌患者的存活率可能反映出无意中暴露于心脏组织的数量 治疗过程中的辐射，可能导致过早死亡。我们最近完成了一项随机试验 比较肺癌患者的质子和光子，发现质子治疗可以显着 减少对心脏的多余辐射。但是，我们尚未调查辐射减少到 心脏的心脏损伤减少，如果心脏暴露的减少可以改善 肺癌患者的生存。损坏的心脏组织释放心脏肌钙蛋白T（TNT），用于 在心脏病学上广泛诊断和监测化学疗法后的心脏损伤和乳房辐射 癌症或淋巴瘤。受损的心脏组织也可以通过PET扫描来可视化和量化。在这个 提案，我们将确定质子治疗减少心脏辐射的心脏暴露是否确实可以减少 肺癌患者的辐射引起的心脏损伤。我们还将确定心脏损伤减少 将改善这些患者的生存。这两个目标将通过使用高度敏感的 对心脏TNT的测定以及在A过程中收集的样品的PET图像的变化 完成了随机临床试验。我们还将调查某些心脏结构是否对 通过利用实施治疗计划的详细剂量法进行辐射。虽然该提议有风险 质子辐射后将找不到心脏益处，它还具有重要的临床潜力 影响可能会导致练习改变的发现。