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. 2020 Oct;15(10):1682-1690.
doi: 10.1016/j.jtho.2020.06.014. Epub 2020 Jun 26.

Incidence and Onset of Severe Cardiac Events After Radiotherapy for Esophageal Cancer

Xin Wang  1 , Nicolas L Palaskas  2 , Syed Wamique Yusuf  2 , Jun-Ichi Abe  2 , Juan Lopez-Mattei  2 , Jose Banchs  2 , Gregory W Gladish  3 , Percy Lee  4 , Zhongxing Liao  4 , Anita Deswal  2 , Steven H Lin  5
Affiliations

Incidence and Onset of Severe Cardiac Events After Radiotherapy for Esophageal Cancer

Xin Wang et al. J Thorac Oncol. 2020 Oct.

Abstract

Introduction: Late cardiotoxicity related to radiotherapy (RT) in breast cancer and Hodgkin's lymphoma has been well-reported. However, the relatively higher cardiac dose exposure for esophageal cancer (EC) may result in the earlier onset of cardiac diseases. In this report, we examined the incidence, onset, and long-term survival outcomes of high-grade cardiac events after RT in a large cohort of patients with EC.

Methods: Between March 2005 and August 2017, a total of 479 patients with EC from a prospectively maintained institutional database at The University of Texas MD Anderson Cancer Center were analyzed. All patients were treated with either intensity-modulated RT or proton beam therapy, either preoperatively or definitively. We focused on any grade 3 or higher (G3+) cardiac events according to the Common Terminology Criteria for Adverse Events, version 5.0.

Results: G3+ cardiac events occurred in 18% of patients at a median of 7 months with a median follow-up time of 76 months. Preexisting cardiac disease (p = 0.001) and radiation modality (intensity-modulated RT versus proton beam therapy) (p = 0.027) were significantly associated with G3+ cardiac events. Under multivariable analysis, the mean heart dose, particularly of less than 15 Gy, was associated with reduced G3+ events. Furthermore, G3+ cardiac events were associated with worse overall survival (p = 0.041).

Conclusions: Severe cardiac events were relatively common in patients with early onset EC after RT, especially those with preexisting cardiac disease and higher radiation doses to the heart. Optimal treatment approaches should be taken to reduce cumulative doses to the heart, especially for patients with preexisting cardiac disease.

Keywords: Cardiac toxicity; Esophageal cancer; Preexisting cardiac disease; Proton beam therapy; Radiotherapy.

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Conflict of interest statement

All authors declare no conflict of interest.

Figures

Fig 1.
Fig 1.. G3+ cardiac events after chemoradiation.
(A) Cumulative incidence plot of death (gray), G3+ cardiac events (gold), and cardiac events adjusted after the competing risk of death (blue). (B) Cumulative incidence of G3+ cardiac events (with noncardiac death as competing risk) for patients with or without pre-existing cardiac disease.
Fig 2.
Fig 2.. Cumulative incidence of G3+ cardiac events (with noncardiac death as competing risk) comparing IMRT vs. PBT.
(A) Cardiac dose volume analysis comparing PBT with IMRT. (B) Cumulative incidence of G3+ cardiac events between IMRT and PBT. Cumulative incidence of G3+ cardiac events for patients with (C) or without (D) pre-existing cardiac disease. Summary data were shown as mean ± SD with P values determined by two-tailed t-test. ****P<0.0001.
Fig 3.
Fig 3.. Cumulative incidence of G3+ cardiac events (with noncardiac death as competing risk)
(A) for patients with 15 Gy MHD cutoff. (B) for patients delivered with different heart V5Gy subgroup (C) for patients with different heart V30Gy subgroup (D) for patients with different heart V50Gy subgroup.
See this image and copyright information in PMC

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