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Cardiac radiation dose predicts survival in esophageal cancer treated by definitive concurrent chemoradiotherapy
Forn-Chia Lin
National Cheng Kung University Hospital
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Radiation Oncology.
Background
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.
Methods
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.
Results
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).
Conclusions
Cardiac radiation dose was inversely correlated with survival in esophageal cancer treated by definitive CCRT. Radiation dose to the heart should be minimized.
Keywords
Esophageal cancer, chemoradiotherapy, intensity modulated radiotherapy, cardiac radiation dose
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CURRENT STATUS: Published
Published
On 22 Sep, 2020
No community comments so far
Editorial decision: Accept
On 03 Sep, 2020
Review #6 received
Received 25 Aug, 2020
Reviewer #4 agreed
On 25 Aug, 2020
Reviewer #5 agreed
On 25 Aug, 2020
Reviewer #6 agreed
On 25 Aug, 2020
Review #5 received
Received 25 Aug, 2020
Review #4 received
Received 25 Aug, 2020
Review #3 received
Received 24 Aug, 2020
Reviewers invited
Invitations sent on 24 Aug, 2020
Reviewer #1 agreed
On 24 Aug, 2020
Reviewer #2 agreed
On 24 Aug, 2020
Reviewer #3 agreed
On 24 Aug, 2020
Review #2 received
Received 24 Aug, 2020
Review #1 received
Received 24 Aug, 2020
Editor assigned
On 23 Aug, 2020
Submission checks complete
On 22 Aug, 2020
Editor invited
On 22 Aug, 2020
Version 1
Posted 09 Jul, 2020
No comments provided
Editorial decision: Major revision
On 06 Aug, 2020
Review #6 received
Received 04 Aug, 2020
Review #2 received
Received 29 Jul, 2020
Review #3 received
Received 27 Jul, 2020
Review #4 received
Received 27 Jul, 2020
Review #5 received
Received 23 Jul, 2020
Reviewer #6 agreed
On 21 Jul, 2020
Reviewer #5 agreed
On 20 Jul, 2020
Reviewer #4 agreed
On 18 Jul, 2020
Review #1 received
Received 18 Jul, 2020
Reviewer #3 agreed
On 18 Jul, 2020
Reviewers invited
Invitations sent on 17 Jul, 2020
Reviewer #1 agreed
On 17 Jul, 2020
Reviewer #2 agreed
On 17 Jul, 2020
Editor assigned
On 08 Jul, 2020
First submitted
On 07 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Editor invited
On 07 Jul, 2020
Metrics
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Subject Areas
Oncology
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This preprint is under consideration at Radiation Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Cardiac radiation dose predicts survival in esophageal cancer treated by definitive concurrent chemoradiotherapy
Forn-Chia Lin
National Cheng Kung University Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Published
On 22 Sep, 2020
No community comments so far
Editorial decision: Accept
On 03 Sep, 2020
Review #6 received
Received 25 Aug, 2020
Reviewer #4 agreed
On 25 Aug, 2020
Reviewer #5 agreed
On 25 Aug, 2020
Reviewer #6 agreed
On 25 Aug, 2020
Review #5 received
Received 25 Aug, 2020
Review #4 received
Received 25 Aug, 2020
Review #3 received
Received 24 Aug, 2020
Reviewers invited
Invitations sent on 24 Aug, 2020
Reviewer #1 agreed
On 24 Aug, 2020
Reviewer #2 agreed
On 24 Aug, 2020
Reviewer #3 agreed
On 24 Aug, 2020
Review #2 received
Received 24 Aug, 2020
Review #1 received
Received 24 Aug, 2020
Editor assigned
On 23 Aug, 2020
Submission checks complete
On 22 Aug, 2020
Editor invited
On 22 Aug, 2020
Version 1
Posted 09 Jul, 2020
No comments provided
Editorial decision: Major revision
On 06 Aug, 2020
Review #6 received
Received 04 Aug, 2020
Review #2 received
Received 29 Jul, 2020
Review #3 received
Received 27 Jul, 2020
Review #4 received
Received 27 Jul, 2020
Review #5 received
Received 23 Jul, 2020
Reviewer #6 agreed
On 21 Jul, 2020
Reviewer #5 agreed
On 20 Jul, 2020
Reviewer #4 agreed
On 18 Jul, 2020
Review #1 received
Received 18 Jul, 2020
Reviewer #3 agreed
On 18 Jul, 2020
Reviewers invited
Invitations sent on 17 Jul, 2020
Reviewer #1 agreed
On 17 Jul, 2020
Reviewer #2 agreed
On 17 Jul, 2020
Editor assigned
On 08 Jul, 2020
First submitted
On 07 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Editor invited
On 07 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Oncology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Radiation Oncology.
Background
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.
Methods
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.
Results
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).
Conclusions
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