Predictive factors for pericardial effusion identified by heart dose–volume histogram analysis in oesophageal cancer patients treated with chemoradiotherapy

Hayashi, Kazuhiko; Fujiwara, Yushi; Nomura, Motoo; Kamata, Minoru; Kojima, Hiroyuki; Kohzai, M; Sumita, Kiyomi; Tanigawa, Noboru

doi:10.1259/bjr.20140168

Cited by 20 publications

(13 citation statements)

References 18 publications

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“…The rates of PCE development in our study were surprisingly high, with 2-year cumulative incidence of 45.4% in the prospective group and 40.8% in the retrospective group. These findings are supported by previous reports of 27.7% to 52.2% for patients with esophageal cancer (15–18), suggesting that PCE may be a common yet underreported toxicity after thoracic RT.…”

Section: Discussionsupporting

confidence: 90%

“…This approach is similar to other studies demonstrating associations with whole heart volume (18, 29, 31), although no consensus has been reached regarding which dose-volume variables are truly significant for PCE development. For example, Hayashi et al .…”

Section: Discussionsupporting

confidence: 56%

“…Previous investigations of esophageal cancer have similarly demonstrated relationships between dose-volume variables and PCE (16, 18, 29–31), yet discrepancies are evident regarding the target volume at risk. A few studies have focused on the pericardium itself, although the defined contour volumes vary widely from paper to paper (16, 30, 31).…”

Section: Discussionmentioning

confidence: 92%

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Incidence and Predictors of Pericardial Effusion After Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer

Ning

Tang

Gomez

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose Findings from RTOG 0617 suggested that collateral radiation to the heart may contribute to early death in patients receiving chemoradiation therapy for non-small cell lung cancer (NSCLC); however, reports of cardiac toxicity after thoracic radiation therapy (RT) remain limited. Because pericardial disease is the most common cardiac complication of thoracic RT, we investigated the incidence of and risk factors for pericardial effusion (PCE) in patients enrolled in a phase II, prospective randomized study of intensity modulated RT (IMRT) versus proton therapy for locally advanced NSCLC. Methods and Materials From July 2009 through April 2014, 201 patients were prospectively treated with proton beam therapy or IMRT to 60-74 Gy with concurrent chemotherapy. The primary endpoint (grade ≥2 PCE) was diagnosed upon review of follow-up images. Clinical characteristics and cardiac dose-volume parameters associated with PCE were identified via Cox proportional hazards modeling and recursive partitioning analysis of null Martingale residuals. Reproducibility was evaluated in a separate retrospective cohort of 301 patients. Results Cumulative incidence rates of PCE among patients in the trial were 31.4% at 1 year and 45.4% at 2 years, with median time to PCE of 8.9 months. Several cardiac dose-volume parameters (e.g., V20–V65) predicted PCE, but heart V35 (HV35) was the most strongly associated, with cut-off volume of 10%. On multivariable analysis, HV35 >10% independently predicted PCE (hazard ratio [HR] 2.14, p=0.002), a finding that maintained reproducibility in the retrospective validation cohort. Other factors associated with PCE included receipt of adjuvant chemotherapy (HR 2.82, p<0.001) and prior cardiac disease (HR 1.68, p=0.020). Conclusions PCE was common after RT for NSCLC, occurring in nearly half of patients even after moderate radiation doses to the heart. Adjuvant chemotherapy may increase the risk of PCE, and HV35 >10% may identify patients at risk for development of this cardiac toxicity.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Incidence and Predictors of Pericardial Effusion After Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer

Ning

Tang

Gomez

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…There are limited data investigating predictors of RP in patients receiving tri-modality therapy for esophageal cancer. Wang et al examined potential predictors of surgical complications in patients receiving tri-modality therapy for esophageal cancer 15 . In their analysis, MLD was strongly associated with increased pulmonary complications.…”

Section: Discussionmentioning

confidence: 99%

Risk of radiation pneumonitis in patients receiving taxane-based trimodality therapy for locally advanced esophageal cancer

Shaikh

Churilla

Monpara

et al. 2016

Practical Radiation Oncology

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Purpose There are limited data regarding clinical and treatment factors associated with radiation pneumonitis (RP) in patients receiving Taxane-based tri-modality therapy for esophageal cancer. The purpose of this study was to identify predictors of RP in patients undergoing tri-modality therapy. Materials and Methods We retrospectively reviewed patients undergoing chemoradiation followed by esophagectomy between 2006-2011. The association between clinical and dosimetric factors with RP was assessed using Chi-square test and Mann-Whitney U test. Multivariable (MVA) regression was used to assess the relationship between grade 2+ RP and clinical/dosimetric factors. Receiver operator curves were generated to identify threshold doses for RP. Results A total of 139 patients were included; 19 (13.7%) patients experienced grade 2+ RP. Patients with upper/middle thoracic tumors (p=0.038) and receiving higher radiation doses (p=0.038) were more likely to develop grade 2+ RP. There was no association between taxane-based therapy and grade 2+ RP (p=0.728). The total lung V5 (p<0.001), V10 (p<0.001), V20 (p<0.001), and V30 (p<0.001) were associated with an increased risk of grade 2+ RP. On MVA, the lung V5 (OR 1.101 95% CI 1.1014-1.195) and V20 (OR 1.149 95% CI 1.1015-1.301) remained associated with grade 2+ RP. A V5≤65% and V20≤ 25% were identified as optimal thresholds for increased grade 2+ RP. Conclusions Dosimetric parameters are strong predictors of symptomatic RP in patients undergoing tri-modality therapy for esophageal cancer. Mitigating the risk of RP in these patients should be an important consideration during treatment planning.

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“…For example, heart V30 and mean heart dose were individually reported to be associated significantly with PCE by Wei et al[8] and Marks et al [20]. But Hayashi et al [19] suggested that V10 of the heart as the most influential factor. For PE, Shirai et al suggested heart V50 as a useful parameter for assessing the risk of PE but not any DVH parameters of the lung [7].…”

Section: Discussionmentioning

confidence: 99%

Bayesian regression analyses of radiation modality effects on pericardial and pleural effusion and survival in esophageal cancer

Chapple

Liao

et al. 2016

Radiotherapy and Oncology

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Background and Purpose To evaluate radiation modality effects on pericardial effusion (PCE), pleural effusion (PE) and survival in esophageal cancer (EC) patients. Materials and Methods We analyzed data from 470 EC patients treated with definitive concurrent chemoradiotherapy (CRT). Bayesian semi-competing risks (SCR) regression models were fit to assess effects of radiation modality and prognostic covariates on the risks of PCE and PE, and death either with or without these preceding events. Bayesian piecewise exponential regression models were fit for overall survival, the time to PCE or death, and the time to PE or death. All models included propensity score as a covariate to correct for potential selection bias. Results Median times to onset of PCE and PE after RT were 7.1 and 6.1 months for IMRT, and 6.5 and 5.4 months for 3DCRT, respectively. Compared to 3DCRT, the IMRT group had significantly lower risks of PE, PCE, and death. The respective probabilities of a patient being alive without either PCE or PE at 3-years and 5-years were 0.29 and 0.21 for IMRT compared to 0.13 and 0.08 for 3DCRT. In the SCR regression analyses, IMRT was associated with significantly lower risks of PCE (HR=0.26) and PE (HR=0.49), and greater overall survival (probability of beneficial effect (pbe) > 0.99), after controlling for known clinical prognostic factors. Conclusions IMRT reduces the incidence and postpones the onset of PCE and PE, and increases survival probability, compared to 3DCRT.

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Predictive factors for pericardial effusion identified by heart dose–volume histogram analysis in oesophageal cancer patients treated with chemoradiotherapy

Cited by 20 publications

References 18 publications

Incidence and Predictors of Pericardial Effusion After Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer

Incidence and Predictors of Pericardial Effusion After Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer

Risk of radiation pneumonitis in patients receiving taxane-based trimodality therapy for locally advanced esophageal cancer

Bayesian regression analyses of radiation modality effects on pericardial and pleural effusion and survival in esophageal cancer

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