Dual effect of radiotherapy related concomitant cardiovascular diseases in non‐small cell lung cancer

BACKGROUND: Nowadays, cancer and cardiac diseases are two of the most causes of death, so cancer treatment‐related cardiac death cannot be ignored. For lung cancer, chest radiotherapy (RT) is essential, but the related cardiotoxicity has not been fully studied. METHODS: We reviewed the data of 11,455 patients with non‐small cell lung cancer (NSCLC) from the Surveillance, Epidemiology, and End Results database from 2001 to 2015. The change trend for concomitant cardiovascular diseases (CVD)‐specific death was calculated and graphically demonstrated. Univariate and multivariate analyses for survival were performed using Cox risk regression model. RESULTS: In our analysis, the overall incidence and mortality from NSCLC declined, but CVD‐specific death increased. Both chemoradiotherapy and radiotherapy alone played a significant role in CVD‐specific death. Analyzed longitudinally from diagnosis, we found that the effect of RT in CVD‐specific death increased continuously over the third years and the hazard ratio for CVD‐specific death was 1.386 times between RT and non‐RT group (HR = 1.386, 95% CI 1.322–1.452; p < 0.0001). On the other hand, RT played a protective role in CVD‐specific death before the second years, especially in recent years from 2013 to 2015 (HR = 0.843, 95% CI 0.740–0.959; p = 0.009). CONCLUSIONS: Although the mortality from NSCLC decreased, but radiotherapy‐related CVD‐specific mortality cannot be ignored. In the long‐term over 3 years, RT significantly promoted CVD‐specific death. However, RT turned to be a protective role in the short‐term within 2 years. In clinical practice, we need to comprehensively consider the dual effects of radiotherapy on the side effect of heart.