Cardiac function after chemoradiation for esophageal cancer: comparison of heart dose-volume histogram parameters to multiple gated acquisition scan changes

Abstract

In this paper we determine if preoperative chemoradiation for locally advanced esophageal cancer leads to changes in cardiac ejection fraction. This is a retrospective review of 20 patients treated at our institution for esophageal cancer between 2000 and 2002. Multiple gated acquisition cardiac scans were obtained before and after platinum-based chemoradiation (50.4 Gy). Dose-volume histograms for heart, left ventricle and left anterior descending artery were analyzed. Outcomes assessed included pre- and postchemoradiation ejection fraction ratio and percentage change in ejection fraction postchemoradiation. A statistically significant difference was found between median prechemoradiation ejection fraction (59%) and postchemoradiation ejection fraction (54%) (P = 0.01), but the magnitude of the difference was not clinically significant. Median percentage volume of heart receiving more than 20, 30 and 40 Gy were 61.5%, 58.5% and 53.5%, respectively. Our data showed a clinically insignificant decline in ejection fraction following chemoradiation for esophageal cancer. We did not observe statistically or clinically significant associations between radiation dose to heart, left ventricle or left anterior descending artery and postchemoradiation ejection fraction.

Early detection of radiation-induced heart disease using 99mTc-MIBI SPECT gated myocardial perfusion imaging in patients with oesophageal cancer during radiotherapy

“…The inability to detect early cardiac toxicity due to RT using the functional LV parameters has been demonstrated previously [15,16,20]. Our results further confirm that the LV functional parameters are not sufficiently sensitive to detect early RIHD.…”

Is cardiac toxicity a relevant issue in the radiation treatment of esophageal cancer?

“…The left ventricular ejection fraction was studied in two papers [8,9], with relatively low patient numbers. Treatment details are listed in Table 1.…”

Morbidity and mortality after surgery for cancer of the oesophagus and gastro-oesophageal junction: A randomized clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiation

“…function, with a dose-dependent decrease in ventricular ejection fraction after different combinations of chemotherapeutic agents and radiation doses. 13,14 Moreover, chemoradiotherapy has been reported to be associated with an increased NT-proBNP release, which is a well-known marker for global heart failure and a strong predictor of postoperative cardiac events. 15,16 Platins and 5-fluorouracil were used in the present trial and are common drugs in chemotherapy regimens for oesophageal squamous cell carcinoma and adenocarcinoma.…”