Symptomatic radiation-induced cardiac disease in long-term survivors of esophageal cancer.
PURPOSE
To evaluate clinical and dosimetric factors retrospectively affecting the risk of symptomatic cardiac disease (SCD) in esophageal cancer patients treated with radiotherapy.


PATIENTS AND METHODS
A total of 343 patients with newly diagnosed esophageal cancer were managed with concurrent chemoradiotherapy or radiotherapy alone. Of these, 58 patients were followed at our hospital for at least 4 years. Median clinical follow-up was 79 months. Cardiac toxicity was determined by Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0. The maximum and mean doses to the heart and percentage of the volume were calculated from the dose-volume histograms.


RESULTS
SCD manifested in 11 patients. The heart diseases included three pericardial effusions, one pericardial effusion with valvular disease and paroxysmal atrial tachycardia, three atrial fibrillations, one sinus tachycardia, one coronary artery disease, one chest pain with strongly suspected coronary artery disease, and one congestive heart failure. The actual incidence of SCD was 13.8 % at 5 years. Univariate and multivariate analyses of continuous variables revealed that the risk of developing an SCD depended on the volume of the heart receiving a dose greater than 45 Gy (V45), 50 Gy (V50), and 55 Gy (V55). No other clinical factors were found to influence the risk of SCD. For V45, V50, and V55, the lowest significant cutoff values were 15, 10, and 5 %, respectively.


CONCLUSION
High-dose and large-volume irradiation of the heart increased the risk of SCD in long-term survivors. Using modern radiotherapy techniques, it is important to minimize the heart dose-volume parameters without reducing the tumor dose.
['Ogino|Ichiro|I|', 'Watanabe|Shigenobu|S|', 'Iwahashi|Noriaki|N|', 'Kosuge|Masami|M|', 'Sakamaki|Kentaro|K|', 'Kunisaki|Chikara|C|', 'Kimura|Kazuo|K|']
D000368:Aged D000369:Aged, 80 and over D015897:Comorbidity D004938:Esophageal Neoplasms D005260:Female D006331:Heart Diseases D006801:Humans D007564:Japan D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D058958:Organs at Risk D015995:Prevalence D000069079:Radiation Exposure D011832:Radiation Injuries D011879:Radiotherapy Dosage D012189:Retrospective Studies D012307:Risk Factors D017741:Survivors D063189:Symptom Assessment
Radiotherapy Chemoradiotherapy Toxicity Hodgkin’s disease Risk factors