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Researchers at Brigham and Women's Hospital used artificial intelligence tools to accelerate understanding of the risk of certain arrhythmias when different parts of the heart are exposed to different thresholds of radiation as part of a lung cancer treatment plan.
The results have been published in JACC: CardioOncology.
“Radiation exposure to the heart during lung cancer treatment can have very serious and immediate effects on a patient's cardiovascular health,” said corresponding author Raymond Mak, MD, of the Department of Radiation Oncology at Brigham and Women's Hospital.
“We want to inform oncologists and cardiologists, as well as patients undergoing radiation therapy, about the cardiac risks involved in treating lung cancer tumours with radiation.”
The emergence of artificial intelligence tools in healthcare is groundbreaking and has the potential to positively transform the continuum of care, such as informing treatment plans for cancer patients.
Cardiac arrhythmias and irregular heartbeats are common in patients undergoing radiation therapy for the treatment of non-small cell lung cancer (NSCLC). Because the heart is so close to the lungs, and because NSCLC tumors are located near or around the heart, the heart can suffer collateral damage from leakage of the radiation dose targeted at the cancer tumor.
Previous studies have found that this type of exposure to the heart is associated with common cardiac problems, but this nuanced study showed that the risk of different types of arrhythmias may vary substantially based on the pathophysiology and cardiac structures exposed to different levels of radiation.
To classify the types of arrhythmias associated with cardiac substructures receiving radiation, the researchers performed a retrospective analysis of 748 Massachusetts patients who underwent radiation therapy for locally advanced non-small cell lung cancer.
Cataloged arrhythmia subtypes include atrial fibrillation, atrial flutter, other supraventricular tachycardias, bradyarrhythmias, and ventricular tachyarrhythmias or asystole.
According to the research team's statistical analysis, about one in six patients experienced at least one grade 3 arrhythmia, and the average time until the first arrhythmia occurred was 2.0 years. A grade 3 classification is considered a serious event that is likely to require intervention or hospitalization. They also found that nearly one-third of patients who experienced arrhythmias also suffered a major adverse cardiac event.
Although the classes of arrhythmias outlined in the study do not fully encompass the range of possible heart rhythm problems, the authors note that these observations improve our understanding of pathophysiological pathways that may occur after receiving radiation therapy and potential means to minimize cardiac toxicity. Their study also provides a predictive model for dose exposure and the types of arrhythmias to expect.
The researchers believe that in the future, radiation oncologists should collaborate with cardiology specialists to better understand the mechanisms of cardiac damage and their relationship to radiation therapy, and they should also take advantage of modern radiation therapy techniques to proactively direct radiation exposure away from certain cardiac regions that are at higher risk of causing arrhythmias.
Mack said this research, along with previous studies, could help inform surveillance, screening and radiation oncologists on where to limit radiation exposure to the heart, ultimately reducing complications.
“What's interesting about what we've done is we've used artificial intelligence algorithms to segment structures such as the pulmonary veins and parts of the conduction system and measure radiation dose exposure in over 700 patients, saving months of manual work,” Mack said.
“Thus, not only does this study have the potential to have clinical impact, it also paves the way for the use of AI in radiation oncology research to streamline discovery and generate larger datasets.”
Further information: Atkins, K et al. “Association of Cardiac Substructure Radiation Dose with Tachycardia and Bradycardia Following Lung Cancer Radiotherapy.” JACC: CardioOncology. (2024) DOI: 10.1016/j.jaccao.2024.07.005.
Courtesy of Brigham and Women's Hospital
Citation: AI Tools Help Uncover Link Between Lung Cancer Radiation Therapy and Cardiac Complications (August 20, 2024) Retrieved August 20, 2024 from https://medicalxpress.com/news/2024-08-ai-tools-uncover-radiotherapy-lung.html
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