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• W2896893726 abstract "To evaluate predictors of cardiac events in esophageal cancer patients treated with neoadjuvant chemoradiation followed by surgery (NA CRT) compared with a cohort of patients treated with surgery alone. We retrospectively identified patients treated for esophageal cancer between January of 2006 and March of 2016. A total of 123 patients were identified; 70 were treated with surgery alone, and 53 were treated with NA CRT. Patients who died <1 month following treatment were excluded, as were patients with upper third esophageal tumors. Cardiac events were scored based on CTCAE v 4.03. Dosimetric data was compiled for all patients who received radiation. Univariate (UVA) and multivariable (MVA) analyses were performed to identify predictors of cardiac events. A competing risk regression analysis was performed (Fine and Gray method) to model the cumulative incidence of cardiac events. Patients in the surgery arm were younger (p = 0.01), had lower ECOG scores (p = 0.03), and lower clinical stage (p = 0.01), than patients who underwent NA CRT. The majority (83%) of the NA CRT patients received a dose of 50.4 Gy (range, 41.4 – 54 Gy). The majority (68%) of these patients were treated with 3D conformal radiation. The overall rates of grade ≥3 cardiac toxicity were 24.5% in the NA CRT group compared with 10% in the surgery group (p = 0.04). The median time to grade ≥3 event was 3.7 months in the NA CRT group compared with 1.7 months in the surgery alone group. The maximum ≥3 grade events included: 5 acute coronary syndromes, 2 new diagnoses of congestive heart failure, 8 arrhythmias, 1 cardiac arrest, 3 pericardial effusions, and 1 pericarditis. Both NA CRT (p = 0.04, HR 2.56, 95% CI 1.06 - 6.67), and pre-existing cardiac disease (p = 0.04, HR 2.63, 95% CI 1.06 - 6.67) were associated with grade 3-5 cardiac toxicity. On MVA, both pre-existing cardiac disease (p < 0.01, HR 3.45, 95% CI 1.41 – 8.32), and use of NA CRT (p < 0.01, HR 3.45, 95% CI 1.35 - 9.09) predicted for grade 3-5 cardiac events. No dosimetric variable predicted for grade ≥3 cardiac events in the NA CRT group. Pericardial effusions (any grade) were significantly increased in the NA CRT group (26.4%) compared with surgery alone (7.1%) (p < 0.01, HR 1.75, 95% CI 1.06 - 2.94). This persisted on MVA (p < 0.01, HR 3.70, 95% CI 1.67 - 8.33). On UVA, the V35 Gy (p = 0.03), V45 Gy (p < 0.01), and V50 Gy (p = 0.04) were predictors of pericardial effusions. On MVA, the V45 Gy was the most significant independent predictor of pericardial effusions (p = 0.012, HR 1.03, 95% CI 1.01 - 1.06). A V45 Gy ≥ 33% cut off was the strongest dosimetric predictor of pericardial effusions (p < 0.001). NA CRT followed by surgery significantly increased the rate of grade ≥3 cardiac events compared with patients treated with surgery alone. While no dosimetric parameter predicted for grade ≥3 cardiac events, the V45 Gy predicted for pericardial effusions. Keeping the V45 Gy to less than one third of the heart volume may reduce the incidence of pericardial effusions." @default.
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• W2896893726 date "2018-11-01" @default.
• W2896893726 modified "2023-09-22" @default.
• W2896893726 title "Predictors of Cardiac Toxicity in Operable Esophageal Cancer Patients Treated with or Without Chemoradiation" @default.
• W2896893726 doi "https://doi.org/10.1016/j.ijrobp.2018.07.451" @default.
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