Mortality from heart disease following radiotherapy in esophageal carcinoma: a retrospective cohort study in US SEER cancer registry

Abstract

Background Recently, multiple studies have focused on cardiac toxicity induced by radiation, particularly in patients with breast carcinoma. However, in most circumstances, the radiation intensity is much higher for the heart in patients with esophageal carcinoma. This study aimed to investigate whether cardiac toxicity is related to radiation and distinguish the types of patients who are more susceptible to cardiac death. Methods We analyzed 8,210 esophageal cancer survivors who were involved in the US Surveillance Epidemiology and End Results (SEER) cancer program. Descriptive statistics were used to demonstrate the disease characteristics in radiation therapy (RT) and non-RT groups. Cox hazard proportional regression and Kaplan-Meier method were applied to determine independent risk factors of cardiac death. Results The most important risk factors determining heart death were age (HR, 14.297; 95% CI: 9.174–22.283) and radiation (HR, 1.952; 95% CI: 1.684–2.263). The radiotherapy performed in the middle (HR, 1.872; 95% CI: 1.464–2.395) and lower thoracic segment of the esophagus (HR, 1.539; 95% CI: 1.464–1.772) was associated with an increased risk of cardiogenic death, which occurred since the first year after diagnosis. Compared with RT in postoperative group (HR, 0.48; 95% CI, 0.37–0.62), patients in preoperative group had a significantly increased survival rate. Conclusions Cardiogenic death is closely related to RT in esophageal cancer patients. Age, radiation sequence and tumor sites are key factors influencing the cardiac death risk induced by radiotherapy. Early detection and prevention are necessary for the high-risk population.

The risks and trends of cardiac-specific mortality associated with chemotherapy or radiotherapy in a large cohort of non-elderly patients with non-small cell lung cancer

“…RT for thoracic cancer induces heart injury and cardiac-related death, especially when the tumor is in the left lung, left breast and the middle/lower thoracic esophageal cancer ( 8 - 10 ). Traditionally, RT-related cardiac diseases are thought to occur in more than 10 years after treatment ( 11 ), so they have long been recognized as a concern only for long-survivors of breast cancer and Hodgkin lymphoma ( 9 , 12 ).…”

Age‐specific cardiovascular disease‐related mortality among patients with major gastrointestinal cancers: A SEER population‐based study

“…The RCS analyses validated that age at diagnosis was linearly associated with CVD mortality. Among esophageal cancer patients, age was regarded as the most risk factor determining heart death, with those aged ≥80 years being 14.297 times at risk for cardiac‐specific survival compared with those aged <40 years 34 . Furthermore, the risk of cardiac mortality increased 1.08‐fold for every 1‐year increase in age 15 .…”

“…Among esophageal cancer patients, age was regarded as the most risk factor determining heart death, with those aged ≥80 years being 14.297 times at risk for cardiac‐specific survival compared with those aged <40 years. 34 Furthermore, the risk of cardiac mortality increased 1.08‐fold for every 1‐year increase in age. 15 Similar to these studies, older esophageal cancer patients had a 4.40‐fold higher risk of CVD‐related mortality than those aged ≤44 years.…”