The study is prematurely terminated due to bad inclusion and the fact that examinations are already being used in standard care.

Severe radiation-induced lung injury (RILI) occurs in approximately 20% of the lung cancer patients, who are treated with curative chemoradiation. In this study the investigators want to evaluate the prognostic value of baseline cardiac function assessed with echocardiography for prediction of RILI.

Severe radiation-induced lung injury (RILI) occurs in approximately 20% of the lung cancer patients, who are treated with curative chemoradiation (CRT).This side-effect can heavily impact quality of life and is a dose-limiting factor for the treatment. Identifying high risk patients before the start of the treatment would make it possible to adapt the treatment by choosing another radiation technique or proton therapy. However, despite the fact that many patient and treatment characteristics have been associated with RILI, it is not possible to accurately predict the risk of RILI for individual patients. Recently, it has been shown that the radiation dose to the heart is a risk factor for lung toxicity in both animal and clinical studies. Also, in a study, carried out jointly by CARIM and GROW, it was found that patients with a previous diagnosis of cardiac disease had a significantly higher risk to develop RILI after CRT (p-value <0.001), even with low or no radiation dose to the heart. It is unknown whether asymptomatic cardiac comorbidity is also related to development of RILI. Taking into account that approximately 30% of all lung cancer patients suffer from symptomatic cardiac comorbidity at the start of cancer treatment, there is an urgent need for research projects focusing on cardio-oncology. These projects will make it possible to unravel the complex relationship between heart, lungs, chemotherapy and radiation treatment. In the current project the investigators hypothesize that biomarkers based on echocardiography, which reflects cardiac function, are prognostic for development of radiation induced lung injury after chemoradiotherapy. In addition, the investigators will validate our previous finding that presence of cardiac comorbidity is associated with RILI.

Inclusion Criteria:

• Clinical stage I-III non small cell lung cancer, excluding malignant pleural/pericardial effusion
• Planned for curatively intended primary (chemo)radiotherapy, due to irresectable disease and/or medical inoperability
• WHO performance status 0-2
• No history of prior chest radiotherapy
• No uncontrolled infectious disease
• No other active malignancy
• No prior lung surgery (VATS, wedge resection, segment resection, lobectomy)
• Willing and able to comply with the study prescriptions
• 18 years or older
• Ability to give and having given written informed consent before patient registration

Exclusion Criteria:

• malignant pleural/pericardial effusion
• history of prior chest radiotherapy
• uncontrolled infectious disease
• other active malignancy
• prior lung surgery (VATS, wedge resection, segment resection, lobectomy)

All patients referred to MAASTRO Clinic with non-small cell lung cancer stage I-III disease can be included in this study (approximately 160 patients per year).