Reduction in myocardial function and oxygen consumption after chemoradiotherapy in patients with esophageal cancer

Søndergaard, Mette; Nordsmark, Marianne; Møller, D.S.; Nielsen, Kirsten; Poulsen, Steen Hvitfeldt

doi:10.1080/0284186x.2022.2048068

Cited by 5 publications

(4 citation statements)

References 34 publications

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“…Ischemia and direct damage to cardiomyocytes are the two main consequences of 5‐FU‐induced cardiotoxicity. Combined radiotherapy and 5‐FU in patients with EC may exacerbate cardiotoxicity and reduce cardiac function [ 41 , 42 , 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict cardiac death after radiotherapy for esophageal cancer

Lv,

Wu,

Liu

et al. 2023

Cancer Innovation

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BackgroundPatients frequently die from cardiac causes after radiotherapy for esophageal cancer. Early detection of cardiac death risk in these patients is crucial to improve clinical decision‐making and prognosis. Thus, we modeled the risk of cardiac death after irradiation for esophageal cancer.MethodsA retrospective analysis of 37,599 esophageal cancer cases treated with radiotherapy in the SEER database between 2000 and 2018 was performed. The selected cases were randomly assigned to the model development group (n = 26,320) and model validation group (n = 11,279) at a ratio of 7:3. We identified the risk factors most commonly associated with cardiac death by least absolute shrinkage and selection operator regression analysis (LASSO). The endpoints for model development and validation were 5‐ and 10‐year survival rates. The net clinical benefit of the models was evaluated by decision curve analysis (DCA) and concordance index (C‐index). The performance of the models was further assessed by creating a receiver operating characteristic curve (ROC) and calculating the area under the curve (AUC). Kaplan‐Meier (K‐M) survival analysis was performed on the probability of death. Patients were classified according to death probability thresholds. Five‐ and ten‐year survival rates for the two groups were shown using K‐M curves.ResultsThe major risk factors for cardiac death were age, surgery, year of diagnosis, sequence of surgery and radiotherapy, chemotherapy and a number of tumors, which were used to create the nomogram. The C‐indexes of the nomograms were 0.708 and 0.679 for the development and validation groups, respectively. DCA showed the good net clinical benefit of nomograms in predicting 5‐ and 10‐year risk of cardiac death. The model exhibited moderate predictive power for 5‐ and 10‐year cardiac mortality (AUC: 0.833 and 0.854, respectively), and for the development and validation cohorts (AUC: 0.76 and 0.813, respectively).ConclusionsOur nomogram may assist clinicians in making clinical decisions about patients undergoing radiotherapy for esophageal cancer based on early detection of cardiac death risk.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict cardiac death after radiotherapy for esophageal cancer

Lv,

Wu,

Liu

et al. 2023

Cancer Innovation

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“…16 A study on patients with esophageal cancer showed a significant reduction in cardiac function and physical capacity immediately after the end of chemoradiotherapy. 17 Cumulative doses of anthracyclines also appear to impact exercise capacity, even in the absence of systolic dysfunction, as shown by a study of childhood cancer survivors. 18…”

Section: Viewpointmentioning

confidence: 98%

Functional Capacity in Cardiotoxicity: Effects of Physical Exercise

Rodrigues¹,

Trindade²

2022

ABC: Heart Failure &Amp; Cardiomyopathy

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Heart failure induced by chemotherapy is an adverse event of cancer treatment that results in high morbidity and mortality. Previous studies have shown that physical exercise improves functional capacity in patients with heart failure due to other etiologies. However, studies with a multimodal approach, including exercise interventions in patients with cardiotoxicity, are still scarce in the literature. The objective of this article was to discuss the effects of physical training in patients with heart failure induced by chemotherapy and the role of cardio-oncological rehabilitation as a tool to improve functional capacity and quality of life in this group of patients.

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“…Nevertheless, various parts of the heart are radiated and affected differently, which mainly depends on tumor localization [1]. The majority of studies have investigated the effect of radiotherapy on the left ventricle (LV) [2,3], whereas the effect on the right ventricle (RV) has been studied significantly less [4][5][6]. Novel reports are more focused on subclinical LV changes that correspond with the deterioration of LV multidirectional strain [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…The majority of studies have investigated the effect of radiotherapy on the left ventricle (LV) [2,3], whereas the effect on the right ventricle (RV) has been studied significantly less [4][5][6]. Novel reports are more focused on subclinical LV changes that correspond with the deterioration of LV multidirectional strain [2,3]. The predictive value of LV functional changes, primarily a reduction in systolic function measured by LVEF, is well-established and recognized by all guidelines, while the predictive function of RV remodeling has recently been documented in cancer patients treated with chemotherapy [7,8].…”

Section: Introductionmentioning

confidence: 99%

Right Ventricle and Radiotherapy: More Questions than Answers

et al. 2023

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The injury of the left ventricle (LV) during anticancer therapy has long been recognized, and guidelines recommend a specific set of parameters for determination of LV impairment. The influence of anticancer therapy on the right ventricle (RV) has been insufficiently investigated, and there are only a few studies that have considered the effect of radiotherapy on RV remodeling. On the other hand, large number of patients with different types of cancers located in the chest are treated with radiotherapy, and the negative clinical effects of this treatment such as accelerated coronary artery disease, valve degeneration and heart failure have been documented. The anatomical position of the RV, which is in the front of the chest, is responsible for its large exposure during radiation treatment, particularly in patients with left-sided breast and lung cancers and mediastinal cancers (hematological malignancies, esophagus cancers, thymomas, etc.). For the same reason, but also due to its anatomical complexity, the RV remains under-investigated during echocardiographic examination, which remains the cornerstone of cardiac imaging in everyday practice. In the last decade many new echocardiographic imaging techniques that enable better evaluation of RV structure, function and mechanics appeared, and they have been used in detection of early and late signs of RV injuries in oncological patients. These investigations are related to some important restrictions that include limited numbers of patients, used parameters and imaging techniques. Many questions about the potential impact of these changes and possible predictions of adverse events remain to be evaluated in future large longitudinal studies. The current body of evidence indicates an important role of radiotherapy in RV remodeling, and therefore, the aim of this review is to summarize currently available data regarding RV changes in patients with various oncological conditions and help clinicians in the assessment of possible cardiac damage.

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Reduction in myocardial function and oxygen consumption after chemoradiotherapy in patients with esophageal cancer

Cited by 5 publications

References 34 publications

Development and validation of a nomogram to predict cardiac death after radiotherapy for esophageal cancer

Development and validation of a nomogram to predict cardiac death after radiotherapy for esophageal cancer

Functional Capacity in Cardiotoxicity: Effects of Physical Exercise

Right Ventricle and Radiotherapy: More Questions than Answers

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