KEY POINTS
- This multicentre retrospective cohort included 194 patients treated at three French centres with SBRT for central or ultracentral lung tumors. The primary cardiac-toxicity analysis included 162 patients with at least 6 months of follow-up.
- Central lesions accounted for 59.8% and ultracentral lesions for 40.2%. Common schedules included 48 Gy in 4 fractions, 50 Gy in 5 fractions, and 60 Gy in 8 fractions; the median prescription EQD₂ was 87.5 Gy.
- CTCAE grade ≥2 cardiac toxicity occurred in 13 patients, 8.0% (95% CI 4.7–13.2%), with a median onset of 12.6 months. Tachycardia and congestive heart failure were the most frequent events, each occurring in 4.3%.
- Prior stroke (adjusted OR 4.17, 95% CI 1.09–15.98) and a primary lung tumor (adjusted OR 4.03, 95% CI 1.12–14.42) were associated with cardiac toxicity in exploratory multivariable analysis. No cardiac-related deaths were reported.
- At 24 months, local control was 78.3% and overall survival was 83.4%. PTV–heart distance and prescription EQD₂ were not significantly associated with cardiac toxicity.
CLINICAL TAKEAWAY
Symptomatic cardiac events after central and ultracentral lung SBRT were uncommon but not negligible, and usually appeared beyond 6 months. Prior stroke may help identify patients who warrant closer cardiovascular assessment, but the retrospective design, limited cardiac surveillance, composite endpoint, and only 13 events make these findings exploratory rather than sufficient to change dose constraints or monitoring protocols.