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Cardiac radiation dose predicts survival in esophageal squamous cell carcinoma treated by definitive concurrent chemotherapy and intensity modulated radiotherapy
Forn-Chia Lin
National Cheng Kung University Hospital
Corresponding Author
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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) remains largely unknown. We aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal squamous cell carcinoma (ESCC) after definitive CCRT.
Methods: One hundred and twenty-one ESCC patients undergoing definitive CCRT with intensity modulated radiotherapy technique between 2008 and 2018 were reviewed. Cardiac dose-volume parameters 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. 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). 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). Patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03).
Conclusions: Cardiac radiation dose inversely correlated with survival in ESCC after 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
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On 25 Aug, 2020
Reviewer #6 agreed
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Received 25 Aug, 2020
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On 24 Aug, 2020
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On 24 Aug, 2020
Reviewer #3 agreed
On 24 Aug, 2020
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Received 24 Aug, 2020
Review #1 received
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Editor assigned
On 23 Aug, 2020
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Editor invited
On 22 Aug, 2020
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Editorial decision: Major revision
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Review #6 received
Received 04 Aug, 2020
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Review #3 received
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Received 27 Jul, 2020
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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
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Reviewer #3 agreed
On 18 Jul, 2020
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Reviewer #1 agreed
On 17 Jul, 2020
Reviewer #2 agreed
On 17 Jul, 2020
Editor assigned
On 08 Jul, 2020
First submitted
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On 07 Jul, 2020
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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 squamous cell carcinoma treated by definitive concurrent chemotherapy and intensity modulated radiotherapy
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
Version 2
Posted 28 Aug, 2020
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
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) remains largely unknown. We aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal squamous cell carcinoma (ESCC) after definitive CCRT.
Methods: One hundred and twenty-one ESCC patients undergoing definitive CCRT with intensity modulated radiotherapy technique between 2008 and 2018 were reviewed. Cardiac dose-volume parameters 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. 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). 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). Patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03).
Conclusions: Cardiac radiation dose inversely correlated with survival in ESCC after definitive CCRT. Radiation dose to the heart should be minimized.
Figure 1
Figure 2
Figure 3