Cardiopulmonary Toxicity of Thoracic Radiotherapy

In the present study, the incidence and time course of treatment-related changes in cardio-pulmonary physiology will be assessed using standard diagnostic tools such as echocardiography, cardiac MRI (CMR) and serum biomarkers and relate them to the radiation dose distribution. Such insight in the characteristics of this possible radiation-induced PH and contributing risk factors is essential to develop primary (radiation dose optimization) prevention strategies.

The general objective of this study is to test the hypothesis that pulmonary hypertension (PH) is a clinically relevant radiation-induced side effect of thoracic irradiation. If confirmed this allows us to take appropriate measures in patient care to improve quality of life in thoracic cancer patients.

To investigate this hypothesis, the following specific aims have been defined:

• To assess the incidence and time course of PH in a prospective cohort study in patients treated with radiotherapy for lung or oesophageal cancer.
• To characterize other changes in myocardial function and pulmonary arteries, and their function using cardiac MR.
• To determine treatment-related risk factors, in particular radiation dose factors to the lungs and heart that could be used for future optimization strategies to minimize the risk of inducing PH in these patients.
• To determine the clinical impact by correlating PH to patient-rated outcome measure (PROMs) and survival. Taken together this study will determine if radiation-induced pulmonary hypertension is a clinically relevant toxicity and will provide information required for future studies on its prevention and treatment. In addition, more insight will be obtained on other forms of cardiovascular damage and complications that may occur in these patients.

Inclusion criteria

• Patients with oesophageal cancer in the mid or distal oesophagus and patients with NSCLC stage IIA-III or NSCLC stage IV with limited brain metastases (treatable with surgery or stereotactic radiosurgery) or SCLC limited disease (stage I-IIIB)
• Scheduled for external-beam radiotherapy with curative intention.
• WHO 0-2.
• Age >= 18 years
• Written informed consent.

Exclusion criteria

• No heart failure in the last 2 months
• No pulmonary embolism in the last 2 months
• COPD gold IV
• BMI >35
• History of thoracic radiotherapy
• Noncompliance with any of the inclusion criteria - For MRI part: Contra indications for MRI

For MRI part:

• contra-indications for MRI