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      Association between radiotherapy and risk of death from cardiovascular diseases in lung and bronchus cancer

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          Abstract

          Background

          Radiotherapy plays an important role in the treatment of lung cancer. However, radiation-related deaths from cardiovascular disease (CVD) are a concern in these patients, and few studies have examined CVD-related death associated with lung cancer. We aimed to evaluate the risk of CVD-related death after radiotherapy in patients with lung and bronchus cancer.

          Methods

          Data were extracted from the surveillance, epidemiology, and end results database. Propensity score matching (PSM) was applied to reduce possible bias between patients who received radiotherapy and those who did not. The Kaplan–Meier method was used to estimate cardiovascular-specific survival (CVSS), and the log-rank test was used to compare CVSS between the radiotherapy and no radiotherapy groups. Cox proportional hazards regression analysis was performed to estimate the hazard ratio (HR) of CVD-related death.

          Results

          A total of 225,570 patients with lung and bronchus cancer were included, and 201,282 patients remained after PSM. Radiotherapy was identified as an independent risk factor for CVSS among patients with lung and bronchus cancer before PSM (HR: 1.18, P < 0.001) and after PSM (HR: 1.18, P < 0.001). Patients treated with radiotherapy had a significantly worse CVSS than those who did not receive radiotherapy before PSM (25-year CVSS: 49.9 vs. 56.4%, P = 0.002) and after PSM (25-year CVSS: 48.4 vs. 56.7%, P < 0.001). Radiotherapy was associated with more deaths from heart disease before PSM (81.9 vs. 77.2%, P < 0.001) and after PSM (83.0 vs. 78.7%, P < 0.001).

          Conclusion

          Radiotherapy is associated with an increased risk of CVD-related death, especially death from heart disease, in patients with lung and bronchus cancer. More efforts are needed to monitor cardiovascular health after radiotherapy.

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          Most cited references47

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          Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial

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            Global Epidemiology of Lung Cancer

            While lung cancer has been the leading cause of cancer-related deaths for many years in the United States, incidence and mortality statistics – among other measures – vary widely worldwide. The aim of this study was to review the evidence on lung cancer epidemiology, including data of international scope with comparisons of economically, socially, and biologically different patient groups. In industrialized nations, evolving social and cultural smoking patterns have led to rising or plateauing rates of lung cancer in women, lagging the long-declining smoking and cancer incidence rates in men. In contrast, emerging economies vary widely in smoking practices and cancer incidence but commonly also harbor risks from environmental exposures, particularly widespread air pollution. Recent research has also revealed clinical, radiologic, and pathologic correlates, leading to greater knowledge in molecular profiling and targeted therapeutics, as well as an emphasis on the rising incidence of adenocarcinoma histology. Furthermore, emergent evidence about the benefits of lung cancer screening has led to efforts to identify high-risk smokers and development of prediction tools. This review also includes a discussion on the epidemiologic characteristics of special groups including women and nonsmokers. Varying trends in smoking largely dictate international patterns in lung cancer incidence and mortality. With declining smoking rates in developed countries and knowledge gains made through molecular profiling of tumors, the emergence of new risk factors and disease features will lead to changes in the landscape of lung cancer epidemiology.
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              Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial

              Systemic relapses remain a major problem in locally advanced rectal cancer. Using short-course radiotherapy followed by chemotherapy and delayed surgery, the Rectal cancer And Preoperative Induction therapy followed by Dedicated Operation (RAPIDO) trial aimed to reduce distant metastases without compromising locoregional control.
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                Author and article information

                Contributors
                Journal
                Front Cardiovasc Med
                Front Cardiovasc Med
                Front. Cardiovasc. Med.
                Frontiers in Cardiovascular Medicine
                Frontiers Media S.A.
                2297-055X
                12 January 2023
                2022
                : 9
                : 1068957
                Affiliations
                [1] 1Department of Geriatrics, Aerospace Center Hospital , Beijing, China
                [2] 2Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences , Beijing, China
                [3] 3Comparative Medicine Center, Peking Union Medical College , Beijing, China
                [4] 4National Human Diseases Animal Model Resource Center , Beijing, China
                [5] 5National Health Committee (NHC) Key Laboratory of Human Disease Comparative Medicine , Beijing, China
                [6] 6Department of Cardiovascular, Aerospace Center Hospital , Beijing, China
                Author notes

                Edited by: Guan Xu, Chinese Academy of Medical Sciences and Peking Union Medical College, China

                Reviewed by: Chu Xianming, The Affiliated Hospital of Qingdao University, China; Michael Spartalis, National and Kapodistrian University of Athens, Greece

                *Correspondence: Meng Zhang, mengzhangmd@ 123456126.com

                This article was submitted to Cardio-Oncology, a section of the journal Frontiers in Cardiovascular Medicine

                Article
                10.3389/fcvm.2022.1068957
                9877540
                1d5b3915-b1bb-4a0f-9fdd-e4c09fb64458
                Copyright © 2023 Yi, Zhang, Wang, Gao, Wang, Li, Ru, Guo, Qiu and Zhang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 13 October 2022
                : 28 December 2022
                Page count
                Figures: 4, Tables: 4, Equations: 0, References: 47, Pages: 9, Words: 5145
                Funding
                This work was supported by grants from the Capital Research Funds for Medical Development (2020-3-6081).
                Categories
                Cardiovascular Medicine
                Original Research

                lung and bronchus,cancer,radiotherapy,cardiovascular diseases,death

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