Cardiac radiation dose predicts survival in esophageal cancer treated by definitive concurrent chemoradiotherapy
The prognostic significance of cardiac radiation dose in esophageal cancer after definitive concurrent chemoradiotherapy (CCRT) without surgery remains largely unknown. This study aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal cancer after definitive CCRT.
A total of 121 consecutive esophageal cancer patients undergoing definitive CCRT between 2008 and 2018 were reviewed. Dose-volume parameters of the heart were calculated. Survival of patients and cumulative incidence of adverse events were estimated by the Kaplan–Meier method and compared between groups by the log-rank test. The prognostic significance of cardiac dose-volume parameters was determined with multivariate Cox proportional hazards regression analysis.
Median follow-up was 16.2 months (range, 4.3-109.3). Median OS was 18.4 months. Heart V5, V10, and V20 were independent prognostic factors of OS. The median heart V5, V10, and V20 were 94.3%, 86.4%, and 76.9%, respectively. Median OS was longer for patients with heart V5 ≤ 94.3% (24.7 vs. 16.3 months, p = 0.0025), heart V10 ≤ 86.4% (24.8 vs. 16.9 months, p = 0.0041), and heart V20 ≤ 76.9% (20.0 vs. 17.2 months, p = 0.047). Moreover, lower cumulative incidence of symptomatic cardiac adverse events was observed among patients with heart V5 ≤ 94.3% (p = 0.017), heart V10 ≤ 86.4% (p = 0.02), and heart V20 ≤ 76.9% (p = 0.0057). The patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03).
Cardiac radiation dose was inversely correlated with survival in esophageal cancer treated by definitive CCRT. Radiation dose to the heart should be minimized.
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Cardiac radiation dose predicts survival in esophageal cancer treated by definitive concurrent chemoradiotherapy
On 22 Sep, 2020
On 03 Sep, 2020
Received 25 Aug, 2020
On 25 Aug, 2020
On 25 Aug, 2020
On 25 Aug, 2020
Received 25 Aug, 2020
Received 25 Aug, 2020
Received 24 Aug, 2020
Invitations sent on 24 Aug, 2020
On 24 Aug, 2020
On 24 Aug, 2020
On 24 Aug, 2020
Received 24 Aug, 2020
Received 24 Aug, 2020
On 23 Aug, 2020
On 22 Aug, 2020
On 22 Aug, 2020
Posted 09 Jul, 2020
On 06 Aug, 2020
Received 04 Aug, 2020
Received 29 Jul, 2020
Received 27 Jul, 2020
Received 27 Jul, 2020
Received 23 Jul, 2020
On 21 Jul, 2020
On 20 Jul, 2020
On 18 Jul, 2020
Received 18 Jul, 2020
On 18 Jul, 2020
Invitations sent on 17 Jul, 2020
On 17 Jul, 2020
On 17 Jul, 2020
On 08 Jul, 2020
On 07 Jul, 2020
On 07 Jul, 2020
On 07 Jul, 2020
The prognostic significance of cardiac radiation dose in esophageal cancer after definitive concurrent chemoradiotherapy (CCRT) without surgery remains largely unknown. This study aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal cancer after definitive CCRT.
A total of 121 consecutive esophageal cancer patients undergoing definitive CCRT between 2008 and 2018 were reviewed. Dose-volume parameters of the heart were calculated. Survival of patients and cumulative incidence of adverse events were estimated by the Kaplan–Meier method and compared between groups by the log-rank test. The prognostic significance of cardiac dose-volume parameters was determined with multivariate Cox proportional hazards regression analysis.
Median follow-up was 16.2 months (range, 4.3-109.3). Median OS was 18.4 months. Heart V5, V10, and V20 were independent prognostic factors of OS. The median heart V5, V10, and V20 were 94.3%, 86.4%, and 76.9%, respectively. Median OS was longer for patients with heart V5 ≤ 94.3% (24.7 vs. 16.3 months, p = 0.0025), heart V10 ≤ 86.4% (24.8 vs. 16.9 months, p = 0.0041), and heart V20 ≤ 76.9% (20.0 vs. 17.2 months, p = 0.047). Moreover, lower cumulative incidence of symptomatic cardiac adverse events was observed among patients with heart V5 ≤ 94.3% (p = 0.017), heart V10 ≤ 86.4% (p = 0.02), and heart V20 ≤ 76.9% (p = 0.0057). The patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03).
Cardiac radiation dose was inversely correlated with survival in esophageal cancer treated by definitive CCRT. Radiation dose to the heart should be minimized.
Figure 1
Figure 2
Figure 3