Predicting radiation-induced valvular heart damage Journal Article


Authors: Cella, L.; Oh, J. H.; Deasy, J. O.; Palma, G.; Liuzzi, R.; D'Avino, V.; Conson, M.; Picardi, M.; Salvatore, M.; Pacelli, R.
Article Title: Predicting radiation-induced valvular heart damage
Abstract: Purpose. To develop a predictive multivariate normal tissue complication probability (NTCP) model for radiation-induced heart valvular damage (RVD). The influence of combined heart-lung irradiation on RVD development was included.Material and methods. Multivariate logistic regression modeling with the least absolute shrinkage and selection operator (LASSO) was used to build an NTCP model to predict RVD based on a cohort of 90 Hodgkin lymphoma patients treated with sequential chemo-radiation therapy. In addition to heart irradiation factors, clinical variables, along with left and right lung dose-volume histogram statistics, were included in the analysis. To avoid overfitting, 10-fold cross-validation (CV) was used for LASSO logistic regression modeling, with 50 reshuffled cycles. Model performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUC) and Spearman's correlation coefficient (Rs).Results. At a median follow-up time of 55 months (range 12-92 months) after the end of radiation treatment, 27 of 90 patients (30%) manifested at least one kind of RVD (mild or moderate), with a higher incidence of left-sided valve defects (64%). Fourteen prognostic factors were frequently selected (more than 100/500 model fits) by LASSO, which included mainly heart and left lung dosimetric variables along with their volume variables. The averaged cross-validated performance was AUC-CV = 0.685 and Rs = 0.293. The overall performance of a final NTCP model for RVD obtained applying LASSO logistic regression to the full dataset was satisfactory (AUC = 0.84, Rs = 0.55, p < 0.001).Conclusion. LASSO proved to be an improved and flexible modeling method for variable selection. Applying LASSO, we showed, for the first time, the importance of jointly considering left lung irradiation and left lung volume size in the prediction of subclinical radiation-related heart disease resulting in RVD. © 2015 © 2015 Informa Healthcare.
Keywords: adolescent; adult; controlled study; treatment response; aged; major clinical study; prednisone; doxorubicin; area under the curve; cancer combination chemotherapy; treatment planning; cancer radiotherapy; outcome assessment; follow up; dacarbazine; lung toxicity; etoposide; radiation injury; prediction; vinblastine; hodgkin disease; dosimetry; probability; bleomycin; epirubicin; radiation safety; chemoradiotherapy; receiver operating characteristic; heart injury; heart volume; lung volume; valvular heart disease; human; male; female; priority journal; article; least absolute shrinkage and selection operator; aorta valve disease; mitral valve disease; radiation induced valvular heart damage
Journal Title: Acta Oncologica
Volume: 54
Issue: 10
ISSN: 0284-186X
Publisher: Informa Healthcare  
Date Published: 2015-01-01
Start Page: 1796
End Page: 1804
Language: English
DOI: 10.3109/0284186x.2015.1016624
PROVIDER: scopus
PUBMED: 25800857
PMCID: PMC4786010
DOI/URL:
Notes: Export Date: 2 December 2015 -- Source: Scopus
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MSK Authors
  1. Jung Hun Oh
    151 Oh
  2. Joseph Owen Deasy
    404 Deasy